Warren CUSD 205 COVID-19 Symptom Self-Check (Summer School)
Please complete for EACH STUDENT DAILY prior to arriving to school or riding on a bus. Per State of Illinois guidelines, we are required to exclude students from school if this form is not completed EVERY DAY.
Email address *
Student Name *
1. Has this student received a confirmed diagnosis for coronavirus (COVID-19) by a coronavirus (COVID-19) test or from a diagnosis by a health care professional in the past 14 days?

2. Has this student had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days?

3. Has this student experienced any cold or flu-like symptoms in the last 14 days (to include: fever or temperature of greater than 100.4 degrees Fahrenheit/38 degrees Celsius, cough, difficulty breathing, sore throat, pressure in the chest, extreme fatigue, earache, persistent headache, diarrhea, and persistent loss of smell or taste)?
How did you respond to these questions? *
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