Daily Covid Health Screening Form
Please complete & submit 1 per family before coming to school.
Sign in to Google to save your progress. Learn more
Name(s): *
Date: *
MM
/
DD
/
YYYY
Are you experiencing symptoms such as fever (>100.4 degrees), cough or shortness of breath? *
Have you been in close contact with anyone who may have COVID-19? *
Are you currently in close contact with anyone who has symptoms or has been confirmed positive for COVID-19? *
Have you been on a cruise or traveled internationally in the last 14 days? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy