Rowley Daily Screening Checklist

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Please fill out this questionnaire every day your child comes to school at Majestic Harbor prior to entering the building. Children with a YES answer to any question will not be allowed to enter. Discovery of any untruthful answers may be prevent further attendance at Majestic Harbor.

Email *

Option 1

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Today's date *

YYYY

Child's name *

Caregiver's name *

Today or in the past 24 hours, have you or any household member had any of the following? *

Fever (temperature 100.0F or above), felt feverish or had chills?

Cough?

Gastrointestinal symptoms (diarrhea, nausea, vomiting)?

Headache?

New loss of smell/taste?

New muscle aches?

Sore throat

Difficulty breathing

Fatigue

Runny nose or congestion

NONE

Required

In the past 14 days, have you had close contact with a person known to be infected with the novel coronavirus (COVID-19)? Close contact is defined as being within 6 feet of an individual who has tested positive for COVID-19 for more than 10 minutes while that person was symptomatic, starting 48 hours before their symptoms began until their isolation period? *

Yes

I certify that my responses to the above checklist are accurate and truthful. *

By checking this box you certify your responses are truthful.

Required

Do you authorize your child to use hand sanitizer with at least 60% alcohol diluted with water under staff supervision? *

Yes

Pick-up time *

Time

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