2021-22 Daily Health Questionnaire
Centreville Preschool, Inc
What is your child's name?
Which class does your child attend today? *please check only TODAY'S class*
Has your child, or anyone in the household, had any of the following symptoms in the last 72 hours?
shortness of breath or difficulty breathing
muscle or body aches
new loss of taste or smell
congestion or runny nose
nausea or vomiting
None of the above
Has there been any use of fever reducing medication within the last 72 hours?
Within the past 14 days, have you/your child been in close physical contact with a person who is known to have laboratory-confirmed COVID-19 or with anyone who has any symptoms consistent with COVID-19?
Is anyone in the household currently waiting on the results of a COVID-19 test?
Do you need to speak to the Health and Safety person today for clarification regarding possible symptoms or concerns?
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