Fall 2020 Fine Arts Activity Health Screening Form
Email address *
Last Name *
First Name *
Grade (2020-21) *
Gender *
Have you had close contact with an individual who is lab-confirmed with COVID-19? For clarity, close contact is defined as: being directly exposed to infectious secretions (e.g., being coughed on while not wearing a mask or face shield); or being within 6 feet for a cumulative duration of 15 minutes, while not wearing a mask or face shield; if any occurred at any time in the last 14 days at the same the infected individual was infectious. *
Have you recently begun experiencing ANY of the following in a way that is not normal for you? 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 *
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