Schnell Student Daily Health Screening
As required by the County Health Officer and According to the Centers for Disease Control and Prevention (CDC)
Student Name *
Teacher Name *
In the last 14 calendar days, has your child traveled out of the U.S.?
Clear selection
Is your child currently experiencing (or have experienced in the past 14 days) one or more of the symptoms of COVID-19, that are new to you, and that are NOT RELATED to any ongoing condition that you have previously or regularly experienced (i.e., seasonal allergies, migraines, sore throat, chronic mild chest congestion associated with common cold, etc.)? Diarrhea, Fever/Chills, Cough, Shortness of Breath, Difficulty Breathing, Fatigue, Congestion/Runny Nose, Nausea/Vomiting, Muscle or Body Aches, Headache, New loss of Taste/Smell, Sore Throat
Clear selection
My child has a temperature of 100.4 or higher without temperature lowering medication.
Clear selection
Is someone in your household, or someone you have come in close contact with (within 6 feet for 15 minutes or more), presenting the symptoms of COVID-19 above?
Clear selection
Never submit passwords through Google Forms.
This form was created inside of Placerville Union School District. Report Abuse