COVID-19 Student Symptoms Questionnaire
Please submit one child per form.
* Required
Student Name:
*
Your answer
Campus:
*
High School
Middle School
Elementary
Other:
Required
Headache:
*
No
Yes
Uncontrolled cough that causes difficulty breathing:
*
No
Yes
Sore Throat:
*
No
Yes
Diarrhea:
*
No
Yes
Feeling Feverish or Measured Temperature Greater Than or Equal to 100.4 Degrees.
*
No
Yes
Known Close Contact with a person who is lab confirmed to have COVID-19 if exposure to the active confirmed case occurred within the last 14 days.
*
No
Yes
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