Student Daily Covid Form
Students will not be able to enter school unless form submitted each MORNING, as symptoms may arise overnight.

Be sure to press “SUBMIT” after completing.
PLEASE NOTE:
Family Name *
Oldest Immacolata Child *
Check all that apply to any of your Immacolata students in your family. If you check yes to any, remain home and review above guidance: Check "NONE" if NO SYMPTOMS, NO CLOSE-CONTACT*, NO FAMILY MEMBER AWAITING TEST RESULTS* (*See below for more info) *
Required
If ANY of your Immacolata children will be absent or late, please list here and list reason (i.e. dentist appointment, Joe had "Close Contact", Jane has two tier 1 symptoms etc) (PLEASE LEAVE BLANK if answer is no). Reminder - Check in at office if arriving after 8:30.
SYMPTOM INFORMATION:
TIER 1 Symptoms: Headache, Fatigue, Sore Throat, Runny Nose / Congestion, Fever, Vomiting, Diarrhea

TIER 2 Symptoms: Shortness of Breath / Difficulty Breathing, Loss of Taste or Smell, Persistent Cough

If student has ONE Tier 1 symptom, student to remain home / leave school. They may return to school after student 24 hours symptom free. No doctor note required. SIBLINGS MAY ATTEND SCHOOL (this is a protocol change made 9/30).

NOTE : If student comes home due to one symptom but then more symptoms appear, please alert school so that siblings may be sent home.

If student has TWO OR MORE Tier 1 symptoms or ANY Tier 2 symptoms, student & Immacolata sibling(s) to remain home / leave school. Student must be evaluated by their healthcare provider and given written clearance prior to school entry.

Further information on "Symptoms Protocols" on our website.
CLOSE CONTACT INFORMATION:
- "Close Contact" is determined if person had close contact with a COVID-19+ individual AND it was within 48 hours of when individual's test was taken if asymptomatic or within 48 hours of individuals's onset of symptoms.

- "Close Contact" includes (within 48 hour info above) if person & COVID-19+ individual were within 6 feet for 15 minutes, shared eating or drinking utensils, if COVID-19+ individual sneezed, coughed or got respiratory droplets on you, or person provided care for COVID-19+ individual.

- If a student tests positive and was at school - your family will be alerted by the school or health department if student in your family had "Close Contact" with the COVID-19+ person.

- If you believe a member of your family has had "Close Contact" outside of the school community, alert the Health Department & Dr. Stutsman. Keep student / family member(s) who had "Close Contact" home from school. Health Department will determine whether other family members within Immacolata School also need to stay home.
AWAITING A TEST RESULT:
- STUDENT SHOULD NOT ATTEND SCHOOL IF THEY ARE AWAITING A TEST RESULT.

- Students should not attend school if MEMBER OF THEIR FAMILY is awaiting test results.

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