Student/Parent COVID-19 Screening Form

All parents/guardians must complete this survey for EACH MORNING that their child comes to a school campus for any reason. Do not fill this out the night before.

Please note: This screening form will be shared with your site principals and secretaries so they can ensure everyone who comes on campus has completed the health screening. This is for everyone's safety. The privacy of your health information is important - we have intentionally kept this form vague so you are not required to report specific symptoms on this form.

If your child has any of the following symptoms, if they feel ill, if they have been exposed to someone with COVID-19 in the last 14 days, or if their temperature is 99.9 F (or 99 F using a contactless thermometer) THEY MUST STAY HOME. Please contact nurse Terri at nurse@scsdk8.org with any questions.
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Email *
Student's Last Name *
Student's First Name *
Student's School *
Student's Grade/Program *
I confirm I am filling this out in the morning when my child is coming to school. I understand it cannot be filled out the night before.
People have reported a wide range of COVID-19 symptoms ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus. These symptoms could include fever, chills, cough, shortness of breath or difficulty breathing, fatigue, headache, sore throat, loss of taste or smell, muscle pain, congestion or runny nose, nausea or vomiting, diarrhea. Individuals with one or more of these symptoms should consider COVID-19 testing.
I confirm that I took my child's temperature today before coming onsite. I confirm that my child is NOT experiencing a temperature above 100.4 degrees Fahrenheit. *
Required
I confirm that my child does NOT have the symptoms listed above OR that if they do have symptoms, they can be better explained by a pre-existing health condition for which I have recent medical documentation from the last 12 months. *
Required
I confirm that in the last 14 days my child has not knowingly been in close contact (within <6 feet for >15 minutes, does not matter if face covering was worn) with someone who has COVID-19 or who is experiencing COVID-19 symptoms. *
Required
I also understand that a parent, guardian, nanny or family member should not come to campus to drop off or pick up students if they have any COVID-19 symptoms or feel sick. *
Required
Parent/Caregiver's Name (First and Last) *
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