COVID-19 Questionnaire
WCA has developed the following questionnaire to assess potential COVID-19 exposure or symptoms. This will be sent home each Friday to be completed and returned each Monday. Your responses will be kept confidential and will be reviewed by a member of administration who will provide guidance in the case of exposure.
Parent Name
WCA Student(s) in Household
Have you or anyone in your household had any of the following symptoms in the last 7 days: sore throat, cough, chills, body aches for unknown reasons, shortness of breath for unknown reasons, loss of smell, loss of taste, fever at or greater than 99.6 degrees Fahrenheit?
Clear selection
Have you or anyone in your household been tested for COVID-19?
Clear selection
Have you or anyone in your household visited or received treatment in a hospital, nursing home, long-term care, or other health care facility in the past 7 days?
Clear selection
Have you or anyone in your household traveled out of state in the past 7 days?
Clear selection
Have you or anyone in your household cared for an individual who is in quarantine or is a presumptive positive or has tested positive for COVID-19?
Clear selection
To the best of your knowledge have you been in close proximity to any individual who tested positive for COVID-19?
Clear selection
Do you have any reason to believe you or anyone in your household has been exposed to or acquired COVID-19?
Clear selection
I certify that I have answered the above questions honestly and have not been misleading by my responses. (typing your name will indicate your assertion that this questionnaire has been answered honestly)
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