Hebron Public School: Gilead Hill School Reason for School Absence
Date Of Absence.
Name Of Absent individual
Grade and Class
Please put a check by any of the following symptoms that the absent individual is experiencing
Fever of 100.4 or above ( oral )
Shortness of Breath
New uncontrolled cough ( above baseline for chronic asthma/allergic cough)
Difficulty in Breathing
New loss of taste or smell
None of the above symptoms
Please check off any of the following symptoms that the absent individual is experiencing
Congestion /runny nose
None of the above Symptoms
Has the absent individual been in close contact (within 6ft for a total of 15 mins or more over a 24 hour period) with a confirmed COVID-19 case?
Is the absence due to the individual having to quarantine due to travel restrictions ?
If the absence is not for any of the other reasons, please state the reason for absence.
Once this has been submitted to the nurse, the nurse will contact you in regards to when the individual can return to school. Please include your email and cell phone number for communication purposes.
Cell phone :
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This form was created inside of Hebron Public Schools.