Daily Health Screening
Please submit this form on a daily basis BEFORE 8:00 a.m. in order for your child to be allowed into the building.
Email *
School Date *
MM
/
DD
/
YYYY
Student's Last Name *
Student's First Name *
Have you or your child knowingly been in close contact (within 6 feet) in the past 10 days with anyone who has tested positive through a diagnostic test for COVID-19 or who has or had symptoms of COVID-19? *
Have you or your child tested positive through a diagnostic test for COVID-19 in the past 14 days? *
Have you or your child experienced any symptoms of COVID-19, including a temperature of greater than 100.0°F in the past 10 days? *
Have you or your child traveled internationally or from a state with widespread community transmission of COVID-19 per the New York State Travel Advisory in the past 10 days? *
Submit
Never submit passwords through Google Forms.
This form was created inside of Gesher Yehuda. Report Abuse