Daily Student Self-Monitoring for COVID-19 Symptoms - 4th Grade
Monitoring daily symptoms can help detect the early onset of illness so that students and staff can isolate themselves from others and reduce their risk of spreading disease. Everyone has a role to play in protecting themselves and others. Self-monitoring for COVID-19 related symptoms is the best method for protecting yourself, family members, friends, and members of the school community.

If your child answers "yes" to ANY of the following questions, please keep him/her home from school.

Parents should contact the school office to report absences and discuss symptoms with the school nurse if needed.

It is extremely important that you immediately report the results of a COVID-19 test so that we can take steps to protect our school community.

Your family's health information will be kept strictly confidential and will only be used to take appropriate and necessary steps to mitigate the spread of disease.
Student Name (First and Last) *
Teacher *
Does the student currently have any of the following symptoms? *
Fever of 100.0 F or higher/chills
Congestion or runny nose (other than allergies)
Sore Throat
Shortness of Breath
Muscle or Body Aches
New loss of taste or smell
Has anyone in your household been diagnosed with COVID-19 by a medical provider? *
Has the student been told by a health care provider or public health official to self-quarantine due to potential COVID-19 exposure(s) or suspicion of having COVID-19? *
Has the student traveled within the last 14 days to a location which requires 14 days of self-quarantine according to Executive Order 7BBB? *
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