CAPCS Student Daily Symptom Survey Grs. 3-9
In an effort to reduce the risk of COVID-19 exposure to College Achieve students and employees all persons entering the building must complete the following screening questions.
Email address *
Date *
MM
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DD
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YYYY
Student First and Last Name *
Grade *
Parent First and Last Name *
Phone Number *
Has the student traveled out of the country or has the student been in contact with anyone who has traveled to high-risk areas within the last 14 days? *
Has the student had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days? *
Has the student experienced any cold or flu-like symptoms in the last 14 days (fever, cough, shortness of breath or other respiratory problems)? *
Type your full name below as your signature and attestation that all provided responses are truthful. *
Submit
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