Daily COVID Student Home Screening -- South Meadows
The Chelsea School District requires daily screening for CSD students prior to entering CSD facilities. Please answer all of the following questions prior to entering any district facility.

Sign in to Google to save your progress. Learn more
Email *
Student's Last Name: *
Student First Name: *
Your child's teachers is:
Clear selection
If your child has any of the following symptoms, this indicates a possible illness that may decrease the student’s ability to learn and also put them at risk for spreading illness to others. Please check your child for these symptoms: *
Yes
No
Temperature 100.4 degrees Fahrenheit or higher
Sore throat
New uncontrolled cough that causes difficulty breathing (for students with chronic allergic/asthmatic cough, a change in their cough from baseline)
Diarrhea, vomiting, or abdominal pain
New onset of severe headache, especially with a fever
If the answer is YES to any of the symptom questions, keep your child home from school.
Close Contact/Potential Exposure: *
Yes
No
In the last 14 days has your child had close contact (within 6 feet of an infected person for at least 15 minutes) with a person with confirmed COVID-19
In the last 14 days has your child had close contact (within 6 feet of an infected person for at least 15 minutes) with person under quarantine for possible exposure to COVID-19
Parents/Home Response
If the answer is YES to any symptom questions and YES to any close contact/potential exposure question, call the school as soon as possible to let them know the reason your child(children) won’t be at school today.  Call your healthcare provider right away.  If you don’t have one or cannot be seen, go to www.mi.gov/coronavirustest or call 2-1-1 to find a location to have your child(ren) tested for COVID-19
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of chelsea.k12.mi.us. Report Abuse
Google Forms