Lake Forest South Elementary School Student Screening Questionnaire
To protect the public against the spread of COVID-19, Governor John Carney and Delaware Division of Public Health are RECOMMENDING that schools screen students and family members each day prior to entering the building using the following questionnaire:

Please remember to continue following preventative measures while in the building:
- Wear a Mask
- Social Distancing
- Go Home When Sick
- Use Cough and Sneeze Etiquette
- Practice Hand Hygiene As Often and Thorough As Possible
- Clean High-Touch Surfaces In Your Area Regularly
Name *
1. In the past 10 days, has the student been near (within 6 feet for at least 15 minutes) a person who has a lab-confirmed case of COVID-19, or has the student had direct contact with their mucus or saliva? *
2. In the last 48 hours, has the student had any of the following symptoms?
Fever of 100.4 F or above (or symptoms like alternating shivering and sweating) *
New cough *
New trouble breathing, shortness of breath or severe wheezing *
New chills or shaking with chills *
New muscle aches *
Sore throat *
Vomiting or diarrhea *
New loss of smell or taste, or a change in taste *
Nausea *
Fatigue *
Headache, congestion or runny nose with no other known cause (such as allergies) *
3. If you answered 'Yes' to any of the symptoms above, do they have a known cause (i.e. asthma, COPD, sinusitis, allergies, etc.)? *
If you answered "Yes" to either question one or two and the symptoms do not have a known cause as identified in question three, do NOT send the student to report to school today and contact your doctor. Please notify the school immediately and keep them informed of the student's progress while self-isolating and prior to determining a date for returning to school.
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