YMHS COVID-19 Student Health Screen Form
CHECK SYMPTOMS DAILY- DO NOT COME TO SCHOOL IF YOU HAVE ANY OF THESE SYMPTOMS
* Required
Email address
*
Your email
Your Name:
*
Your answer
Date:
*
MM
/
DD
/
YYYY
Fever 100.4°F or above
*
Yes
No
Cough
*
YES
No
Other:
Shortness of breath or difficulty breathing
*
YES
No
Other:
Chills
*
YES
No
Muscle or body aches
*
YES
No
Other:
Sore throat
*
Yes
No
Other:
New loss of taste or smell
*
Yes
No
Other:
Nausea or vomiting
*
Yes
No
Other:
Diarrhea
*
Yes
No
Other:
Since you last cohort day, have you be in contact with anyone diagnosed with COVID-19?
*
Yes
No
Maybe
What to do if you have symptoms of COVID-19 or documented exposure
https://docs.google.com/document/d/e/2PACX-1vSG02-HD1ItQXpNCsYR_K9HKNZ5pd7CKcfaBBjh-eCK2usd446R9Q-0tf07mLO6ug/pub
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