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Sample Daily Health Screening for Students
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* Indicates required question
1. Do you or your child live with anyone or have you or your child had close contact with anyone with a prolonged cough, fever, flu-like symptoms or been diagnosed with COVID-19 within the last 14 days?
*
Yes
No
1. Do you or your child live with anyone or have you or your child had close contact with anyone with a prolonged cough, fever, flu-like symptoms or been diagnosed with COVID-19 within the last 14 days?
*
Yes
No
2. Do you or your child live with anyone, have had close contact or do you or your child have a fever, cough and/or shortness of breath? For children and adults, fever is 100.4 degrees or above using a forehead thermometer.
*
Yes
No
3. Do you or your child live with anyone, have had close contact or do you or your child have any other signs of communicable illness such as a cold, flu, rash or inflammation?
*
Yes
No
4. Do you or your child live with anyone, have had close contact or have you or your child experienced diarrhea or vomiting (within the past 24 hours)?
*
Yes
No
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