Metropolis Elementary Temporary Student Health Screener - Tuesday, September 15, 2020
This form will be utilized for student Pre-screening that is required by the ISBE and IDPH until the new Application is launched. Please take a moment to screen your children prior to sending them to school. If your child has a fever of 100.4 or has multiple symptoms that are not normal for your child during this time of the year, please keep your child home and notify the school of their absence. This is simply a precautionary measure due to the current health risks. Thank you for your help with this.
What is the student's first name?
What is the student's last name?
What is the student's grade level?
1.) Do you have a temperature of 100.4 or higher?
2.) Please mark any/all of the following symptoms you are currently experiencing.
Shortness of breath or difficult breathing
Muscle and body aches
Loss of taste or smell
Congestion or runny nose
None of the Above
3.) Close Contact/Potential Exposure: Please mark all that apply
In the past 14 days, had Close Contact (within 6 feet of an infected person for at least 15 minutes) with a person with confirmed COVID-19?
In the past 14 days, had close contact with (within 6 feet of an infected person for at least 15 minutes) with person under quarantine for possible exposure to CoVID19?
Traveled to or lived in an area where the local, Tribal, territorial, or state health department is reporting large numbers of COVID-19 cases.?
Have you traveled out of the country (internationally) in the past 14 days?
Have you traveled out of the State of Illinois in the past 14 days (not including Western Kentucky)?
Within the past 14 days, has a public health or medical professional told you to self-monitor, self-isolate, or self-quarantine because of concerns about COVID-19 infection?
None of the Above
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This form was created inside of Massac Unit School District #1.