Sample Daily Health Screening for Students

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

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

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

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

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

Submit

Clear form

This form was created inside of Marin County Office of Education.

Does this form look suspicious? Report

Forms