Christ the Teacher: Daily Screening for Students
Parent or Guardian MUST fill out Checklist for the Student before coming to school.
Fill in this form once per day. Only use your Child's name. Do not combine the first name of Students in the same household with the same last names.
This form will start collecting data at 12:00 AM every day and stop at 3:00 pm.
Student's First Name *
First name as it appears on school registration
Student's Last Name *
Last name as it appears on registration
1. Is your Child feeling well today? *
If the parent observes that they do not look or act well this should be marked as "No". If your child verbally indicates that they are not feeling well then mark "No".
2. Does your Child or any family member (in the household) CURRENTLY have ANY of the following SYMPTOMS that cannot be connected to another health issue? *
Symptoms present within the past 24-hours
No
Yes
COUGH
SHORTNESS OF BREATH OR DIFFICULTY BREATHING
SORE THROAT
CHILLS
RECENT LOSS OF TASTE OR SMELL
HEADACHES
CONGESTION OR RUNNY NOSE
NAUSEA OR VOMITING
DIARRHEA
3. Has your child or any family member (in the household) been in close contact in the last 14-days with an individual diagnosed with COVID-19? *
4. Have your Child (STUDENT) taken Tylenol or Ibuprofen in the last six hours to treat a fever or chills? *
(Advil, Motrin or other generic medication used or prescribed to reduce fever or chills)
Staying Home? *
Is your Child staying home today? Answering "Yes" to this question will communicate your intent to the school staff.
If your child answers "YES" to any question please keep them home for today. A "YES" response will send an email notification to the school's administrative personnel and you will be contacted later this afternoon.
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This form was created inside of Catholic Charities Serving Central Washington. Report Abuse