Daily Covid-19 Screening Questionnaire
If you answer YES to any of the following questions, your child MAY NOT attend school today, and we ask that you please check in with the school office.

If you are a staff member, please fill out the questions as if "your child" reads "you or your"
Parent/Staff E-mail *
Child's (or Staff) Last Name *
Child's (or Staff) First Name *
Class *
Does your child have any of the following symptoms: temperature over 100.3, cough, congestion or runny nose, chills, headache, muscle pain, sore throat, loss of taste or smell, shortness of breath, fatigue, nausea, or vomiting? *
1 point
Has your child traveled in the past 10 days? *
Children must follow the CDC guidelines for unvaccinated people which includes a test 3-5 days after returning home AND a 7-day self-quarantine period.
1 point
Is your child, or someone in your household, currently awaiting Covid-19 test results? *
1 point
My child has had close contact with a Covid-19 positive case in the past 14 days. *
1 point
Comments/Clarifications
By entering my initials, I certify that this information is accurate for the above named child on today's date. *
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