Students Covid Screening Form 2021-22
Parents and guardians, use this checklist every day before sending your children to school.
Fill out a separate form for each child.
If you answer “YES” to one or more questions, you must keep your child home from school today.
Email *
Student Name *
Student Grade *
Does your child have any new, unusual or worsening symptoms from List 1 or List 2 below? If the answer to any of the questions is “yes”, keep your child home and consult your primary care physician. If a doctor determines that the symptoms are due to another diagnosis, or COVID-19 is ruled out, your child may return to school after being fever-free for 24 hours without the use of fever-reducing medications.
Does your child have any new, unusual or worsening symptoms as listed? List 1: Does your child have any 2 of these symptoms? Fever (100.4 F or greater) or chills? Cough? Shortness of Breath or Difficulty breathing? Loss of smell or taste? Sore throat? Congestion or runny nose? Nausea or vomiting? Diarrhea? *
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