𝙋𝙡𝙚𝙖𝙨𝙚 𝙘𝙤𝙢𝙥𝙡𝙚𝙩𝙚 𝙖𝙣𝙙 𝙨𝙪𝙗𝙢𝙞𝙩 𝙙𝙖𝙞𝙡𝙮 before arriving at school

Your responses are safe and confidential.

You must submit 𝑻𝑾𝑰𝑪𝑬, 𝒐𝒏𝒄𝒆 on this page, and 𝒐𝒏𝒄𝒆 on the next.

School *

Child's First & Last Name *

Please, only submit one child per form.

Has your child been in close contact with someone with COVID-19 in the last 14 days? *

Yes

Does the student feel unwell with any symptoms consistent with COVID-19? *

COVID-19 symptoms include the following: ¤ Cough ¤ Fever (100.4 or greater) ¤ Shortness of breath ¤ Chills ¤ Fatigue ¤ Muscle pain or body aches ¤ Headache ¤ Sore throat ¤ Loss of taste or smell ¤ Congestion or runny nose ¤ Nausea, vomiting or diarrhea (diarrhea is defined as frequent loose or watery stools compared to child’s normal pattern)

Yes

Has the student had a fever greater than 100.4 in the past 24 hours? *

Yes

In the past 14 days have you traveled for a non-essential purpose to an area that requires quarantine when returning to VT? *

Any leisure travel is considered non-essential. This includes visiting family, shopping for clothes, recreation/sports, hunting. plus others. Essential purposes include essential shopping (such as food and medicine), medical/dental appointments, and work-related travel. Answer "no" to this question if you have answered "yes" previously and that trip has already been cleared by a school nurse/administrator as essential travel which does not require quarantine. If unsure ask your school nurse or look up information or you can check the cross-state travel map here: https://accd.vermont.gov/covid-19/restart/cross-state-travel

Yes

N/A - (It has been 14 days since I got my final vaccine dose)

What is your temperature today?

Don't worry if you can't take your temperature at home. You will be re-screened at the school.

Did you answer YES to any of the above questions OR was your temperature greater than 100.4? *

Yes

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