Daily Health Check Form
Please complete the form for each child in your household prior to his/her arrival at school. This form MUST be completed on a daily basis in the MORNING ONLY. The form submission is time-stamped and will be checked for a morning submission time. Students will not be permitted to travel to their classrooms without the health check form being submitted each day. Administrators and the SRO will be verifying form completion as students enter the building for temperature screenings. Any students without submitted forms will be held in the Nurse's Office until a parents can be contacted to submit the daily form.
Student/Staff Last Name *
Student/Staff First Name *
Grade Level or Building Role
Please select any symptoms your children has experienced this morning from the follow list (2 or more symptoms excludes students from participation in on-site instruction): *
Required
Please select any symptoms your children has experienced this morning from the follow list (1 or more symptom(s) excludes students from participation in on-site instruction): *
Required
Please verify if (if ANY of the following fields are checked off other than 'None of the Above', your child should remain home for 14 days from the last day of exposure: *
Required
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