Fowler Daily Health and Building Check-In
Please fill this out before or when entering the building. All questions are mandatory
Name *
I am a *
If a student, which grade?
Clear selection
Expected arrival time *
Time
:
Expected departure time *
Time
:
1. I feel well today. *
Required
2. I DO NOT have any signs or symptoms of illness - including, but not limited to: **Fever (100.0° Fahrenheit or higher), chills, or shaking chills **Cough (not due to other known cause, such as chronic cough) **Difficulty breathing or shortness of breath ** New loss of taste or smell **Sore throat **Headache when in combination with other symptoms (not due to other known causes, such as seasonal allergies) **Muscle aches or body aches **Nausea, vomiting, or diarrhea **Fatigue, when in combination with other symptoms **Nasal congestion or runny nose when in combination with other symptoms (not due to other known causes, such as seasonal allergies) *
Required
3. In the past 14 days, I have NOT been a close contact to anyone with a known diagnosis of COVID-19. *
Required
4. If I have traveled outside of Massachusetts in the past 14 days I will NOT come to school and I will notify the nurse. *
Required
5. I have NOT taken any fever reducing medication in the last 24 hours specifically used to reduce a fever. *
Required
The school has up-to-date emergency contact information in the event I need medical care. *
Required
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