Daily Check In Survey
Please note that the completion of this survey is a requirement of the Dept of Health
* Required
Name
*
Your answer
Surname
*
Your answer
Gender
*
Male
Female
Pleaase categorize yourself
*
Gr.1-3
Gr.4-7
Gr8-12
Staff
Visitor
Youth Brigade
Age
*
Your answer
Temperature today
*
Choose
Normal
Fever (38 or higher
Were you in contact with a person with COVID-19
*
yes
No
Have you experienced any of the following Symptoms?Coughing, sore throat, shortness of breath, loss of smell/taste, etc.
*
Yes
No
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
