Belleville Henderson COVID-19 Screening Questionnaire for Students
COVID-19 Screening Questionnaire Belleville Henderson Students - Under the guidance of the NYS Department of Health, Belleville Henderson District is requiring that parents and students complete this health screening questionnaire every Monday.
Students or Parents: Complete this form prior to reporting to school. If you answer “yes” to any questions, do not report to Belleville Henderson School and notify your supervisor immediately. You must wear a facial covering to enter Belleville Henderson School.
This is a requirement. Symptoms of COVID-19 may include: headache, fever or chills; cough; shortness of breath or difficulty breathing; fatigue; muscle or body aches; headache; new loss of taste or smell; sore throat; congestion or runny nose; nausea or vomiting; diarrhea.
Contact Information:
kbertram@bhpanthers.org
Cell phone: 315-486-0513
*****Both remote only and in-person learners need to have this information reported.*****
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Please list your child's name (this form is for one child only).
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Your answer
Does your child have a temperature of 100 degrees?
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Yes
No
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