Lindop Student Daily COVID Screening Form (PreK-8th)

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Note: This information is private and will only be viewed by screener, administration and/or nurse.

This screening form must be completed for EACH student daily by 7:45 a.m.

No fever-reducing medication has been taken prior to arrival to the building.

I understand that if my child becomes symptomatic during the school day, I will make arrangements to have my child picked up as soon as possible (if necessary) at DOOR H (2nd/3rd grade door).

Email *

Student's Name *

Today's date *

YYYY

Grade Level *

Homeroom Teacher *

RECENT EXPOSURE: My child has had recent contact (within the last 14 days) with someone who is diagnosed/known COVID-19 positive. *

Yes

SYMPTOMS: My child is experiencing ONE OR MORE OF THE FOLLOWING: cough, shortness of breath, sore throat, nausea, vomiting, diarrhea, abdominal pain, new loss of taste or smell, chills, headache, muscle pain, fatigue, nasal congestion, runny nose *

Yes

Send me a copy of my responses.

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