GLM Illness Tracking 2020
Please help GLM have a clear picture of illness in our community by filling out this ANONYMOUS form to self-report any recent illness. Unless you are the parent or guardian of a student, please do not fill out this form on behalf of another person as this may affect the data.

If you (or your child) has a new symptom to add to an already submitted form, please note that in the first question. As this form is anonymous, we won't have a way of connecting two submissions about the same illness and we therefore ask that you make sure to submit all pertinent information, even if submitting for a newly developed symptom. Thank you for your support on this.
Have you already submitted this form for this illness? If not, are you adding a new symptom? *
Relation of Person to GLM *
Age Range of Person *
Select the Classroom(s) the Person is Affiliated With: *
Required
Date of Symptom Onset (Approx) *
MM
/
DD
/
YYYY
Approx Length of Illness
Clear selection
Main Symptoms: Fever? *
Main Symptoms: Cough (Dry)? *
Main Symptoms: Cough (Wet)? *
Main Symptoms: Shortness of Breath? *
Main Symptoms: Stuffy/Runny Nose? *
Main Symptoms: Headache? *
Main Symptoms: Fatigue? *
Main Symptoms: Sore Throat? *
Submit
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