Mrs. Payne - COVID-19 Daily Self Checklist

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Parents/Guardian: Please review this Covid-19 Daily Self Checklist every day for each WCSD student in your household. If you've checked anything other than "NONE OF THE ABOVE" in QUESTION 2, your child may not be permitted to attend school. Please contact the school clinic right away for guidance and directions.

1) Your child's name (Last, First) *

2) Please check all that apply: *

My child has tested positive for COVID in the past 10 days.

Within the last 10 days, my child has been in close contact, unmasked, for at least 10 minutes (within 6 ft) with someone who has tested positive for COVID-19 or is awaiting test results for COVID-19.

My child has been tested for COVID-19 and is awaiting results.

My child has experienced one or more COVID-19 symptoms in the 10 days (symptoms include but are not limited to fever (>100.0 without medication), runny/stuffy nose, fatigue, chills, muscle pain, loss of taste/smell, difficulty breathing, coughing, sore throat, gastrointestinal issues).

My child has been asked to self-isolate or quarantine by a medical professional, local public health office, or school officials.

None of the above

Required

3) I hereby certify that the above statements are true and correct. *

I agree.

4) Choose a statement below based on the answers in your checklist. *

I have selected YES to one or more question(s) and I will seek medical attention.

I have selected NO to each question and I feel it is safe for my child to be in school today.

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