Daily Health Screening
COVID-19 Check for Nautilus Learning
Sign in to Google to save your progress. Learn more
Today's Date *
Pod Member's Full Name *
Does the Pod Member have any of the following symptoms? *
Has the Pod Member had any of the above symptoms in the past 3 days? *
Does anyone in your household have any of the above symptoms? *
Has the Pod Member been in close contact with anyone suspected or confirmed COVID-19 in the past 14 days? *
Has the Pod Member had a positive COVID-19 test for the active virus in the past 10 days? *
Has the Pod Member had any medication to reduce a fever before coming to the Pod today? *
Submit today's temperature *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Nautilus Learning Pods. Report Abuse