SAEL Student Daily Symptom Checklist
Every time you come to campus, you need to submit this checklist. You only need to do one per day. After you submit the form you will receive a response from your submission. Show your response to your teacher as proof of completion.
Email *
First Name *
Last Name *
Grade Level *
Crew Advisor *
Symptom Checklist
You do not always know which people have a chronic illness or underlying health condition that increases their risk for serious consequences from Covid-19. By monitoring your family for symptoms and keeping your potentially sick family member home from school or work, you are helping to protect every child and adult in our community.

If you are having difficulty with at home symptom checks or temperature taking, please contact the school to make other arrangements.

If you answer “YES” to any of the below questions, please refer to the instructions in the next part of this form after the checklist.
Select YES or NO for the following symptoms: *
Yes
No
Exposed to COVID 19 in the past 14 days
Feeling Ill
Temperature greater than 100.4F?
Any of the following symptoms: Cough, Shortness of breath / difficulty breathing, sore throat, congestion or runny nose, muscle or body ache (not due to exercise), fatigue, headaches, chills, new loss of taste or smell, repeated shaking with chills, vomiting and/or nausea (unrelated to anxiety or eating), diarrhea
If you answered YES, contact Ms. Perez-Carpenter: m.perez@sierraacademy.net
RELEVANT TO SCENARIO ONE: If the staff/student has answered YES to one or more of the Daily Symptom Check questions, then they should STAY HOME, CONTACT THE SCHOOL, and follow up according to one of the following:

A. If the staff/student answered YES to one or more of the Daily Symptom Check questions and they followed up with a Covid- 19 test that had a negative result, then they may return to work/school when the following conditions are met:
-May return to school 3 days after symptoms resolve
-Submission to school of negative Covid-19 test

B. If the staff/student answered YES to one or more of the Daily Symptom Check questions and they followed up with a Covid- 19 test that had a positive result, then they may return to work/school when the following conditions are met:
-It has been 10 days since the onset of symptoms or test date for the specific person
-And 3 days after symptoms resolve

C. If the staff/student answered YES to one or more of the Daily Symptom Check questions and they have not had a Covid-19 test, then they should consult their healthcare provider who will decide if they are a candidate for Covid-19 testing.
-If the physician recommends testing, then depending on the result of the test, see A or B above.
-If testing is not recommended by their healthcare provider, then staff/student may return to work/school when the following conditions are met:
 3 days after symptoms resolve
 Submission to school of physician note stating the Covid-19 test not needed

D. If the staff/student answered YES to one or more of the Daily Symptom Check questions and they have not had a Covid test and have chosen not to contact their healthcare provider, then they may return to work/school when the following conditions are met:
o It has been 10 days since the onset of symptoms
o And 3 days after symptoms resolve

E. If the staff/student answered YES to one or more of the Daily Symptom Check questions and they have been fully vaccinated within the last 90 days and has had a known exposure to Covid, they have Two Options:
1) Test with PCR and isolate until results
-If negative, stay home until symptoms markedly improved or
resolved
-If positive, isolate and trace close contacts
2) Isolate for 10 days

F. If the staff/student answered YES to one or more of the Daily Symptom Check questions and they have been fully vaccinated within the last 90 days and has NOT had a known exposure to Covid:
-Isolate until symptoms are markedly improved or resolved

G. If the staff/student answered YES to one or more of the Daily Symptom Check questions and they have previously tested positive for Covid within the last 90 days, whether or not they had a known exposure to COVID:
-No isolation required
-Stay home until symptoms markedly improved or resolved.

H. If the staff/student answered YES to one or more of the Daily Symptom Check questions and they have previously tested positive for Covid, and it's been more than 90 days since the positive test:
-Follows the standard NCPH protocol for exposure and/or symptoms that all other staff and students follow.

Please contact your school Administration if you have any questions or concerns. Seek medical attention if your Covid-19 symptoms become severe, including persistent chest pain or pressure in the chest, confusion or bluish lips or face.

**WHO IS A CLOSE CONTACT? A close contact is defined as a person who is <6 feet from a case for >15 minutes. In some school situations, it may be difficult to determine whether individuals have met this criterion and an entire cohort, classroom, or other group may need to be considered exposed, particularly if people have spent time together indoors.

† WHAT IS A COHORT? A cohort is a stable group with fixed membership that stays together for all courses and activities (e.g., lunch, recess, etc.) and avoids contact with other persons or cohorts.
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