L'école - French School of Raleigh COVID questionnaire
2020-21 PRESCHOOL and KINDERGARTEN COVID QUESTIONNAIRE
Please fill this questionnaire before you bring your child to school to evaluate your risk of being infected with COVID 19.
Students who have symptoms of acute respiratory illness are recommended to notify their supervisor if they have signs of a fever and any other symptoms within at least 24 hours, without the use of fever-reducing or other symptom-altering medicines (e.g. cough suppressants), and stay home until they are free of fever (100.4° F [38.0° C] or less using an oral thermometer)
* Required
Name of the child:
*
Your answer
Select class:
*
Choose
TPS
PS
MS
Kindergarten / GS
Afterschool - Laurence Elia FLE
Afterschool - Anne-Cécile Poignant
Afterschool - Anne-Çécile Peyrelongue
Afterschool - Lydia Fabre
Afterschool - Alexandra Hauffen
First name and Last name of the parent
*
Your answer
Do you have any of the following?
*
Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
None of the above
Required
Are you ill, or caring for someone who is ill?
*
• Students who are well but who have a sick family member at home with COVID-19 should notify the school.• If a student is confirmed to have COVID-19, the family should inform the school of their possible exposure to COVID-19. The school will maintain confidentiality as required by the Americans with Disabilities Act (ADA).
Yes
No
In the two weeks before you felt sick
*
Did you have contact with someone diagnosed with COVID-19?
Did you live in or visit a place where COVID-19 is spreading?
None of the above
Required
Submit
Page 1 of 1
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
