Staff Daily COVID-19 Symptom Assessment
You must fill out this form daily to verify that you have not displayed any of these symptoms before coming to school.
Email address *
Does you have: *
Fever 100.4 degrees or greater?
Cough, sore throat, or difficulty breathing?
Chills or muscle or body aches?
Nausea, vomiting, or diarrhea?
Unexplained rashes or blister-like sores on the skin?
Sudden loss of taste or smell?
A family member or close contact with any of the above symptoms?
Have you been in close contact with anyone diagnosed with COVID-19 or anyone who has been placed in quarantine for possible exposure of COVID-19?
Have you or anyone in your family been asked to self-isolate¹ or quarantine by a medical professional or local public health official?
Have you/your family recently traveled to or from an area with increased cases/spread of COVID-19?
If you have answered yes to any of these statements, please stay at home and contact the school. By submitting this form, you are confirming that you are in good health.
NOTE: ¹Self-isolation is defined by having been in a high risk situation, such as exposure to someone who has a confirmed COVID 19 diagnosis. Quarantine is defined by a person who has COVID 19 or has symptoms and is awaiting test results.
This form was created inside of Saint Leo the Great School, Oakland, CA. Report Abuse