Soundscapes Health Screening
Students:
Prior to each day, please complete this health screening for your child to participate in Soundscapes.

Students must bring at least one cloth or paper face mask to school each day.
-Masks will be worn while riding the bus, in common areas at school, and as indicated in the classroom
setting.
-If your student is unable to wear a mask for medical reasons, please contact the school.
-Please clearly label masks with the student’s and teacher’s name.
-It is helpful to send a second mask. Cloth masks should be washed daily and paper masks replaced daily.

Masks will be worn while riding the bus, in common areas at school, and as indicated in the classroom

Staff:
Staff must fill this form out in-order to gain entry into a program site building and visit/work with Soundscapes students. Masks must be worn while in the building.
Sign in to Google to save your progress. Learn more
Site Name *
Student/Staff Name *
Do you have a fever? (If your temperature is more than 100.4°F, you may not attend school.) *
Have you been exposed to someone with COVID-19 in the past 14 days? *
Fully vaccinated employees that have had close contact with someone known or suspected to have COVID-19 in the past 14 days must self-monitor for symptoms but may continue working as long as no symptoms are present.
Do you feel ill? *
Do you have: *
No
Yes
Cough
Chills
Fatigue
Muscle or body aches
Congestion or runny nose
Sore throat
Headache
New loss of taste or smell
Nausea
Vomiting (unidentified cause, unrelated to anxiety or eating)
Diarrhea
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Soundscapes. Report Abuse