K-8: HNM Health Screening
Must be completed daily before coming to the HNM Campus.
Student's Name (if multiple students/add all on this line)
Student's Last Name
Do you have a fever over 100.4? Be sure to check your individual thermometer for equivalent readings. Do you have chills, or a new cough, or shortness of breath/difficulty breathing, or a new loss of taste or smell?
Have you been around anyone who has tested positive with COVID-19 within the last 14 days?
Are you subject to a quarantine or isolation order?
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Holy Name of Mary School.