In order to reduce the amount of students and reduce exposure to COVID-19, Please DO NOT SEND STUDENTS directly to nurse's office, complete this form and the nurse will call for them, unless a true emergency (broken bone, seizure etc.)
Sign in to Google
to save your progress.
Emergency? (ACTIVE SEIZURE, LIFE THREATENING ALLERGIC REACTION, SIGNIFICANT PHYSICAL INJURY, STUDENT PASSED OUT,ETC.)
Yes (FIRST PAGE THE OFFICE AND STATE THE LOCATION OF THE EMERGENCY)
Reason for visit: Check all that Apply
Shortness of breath or difficulty breathing
Muscle or body aches
New loss of taste or smell
**OTHER- PLEASE LIST THE REASON BELOW
**FOR OTHER REASON-Brief description for need of nurse visit
Page 1 of 1
Never submit passwords through Google Forms.
This form was created inside of Southwest ISD.