SFIS Daily Health Screening
Please complete and submit the following questionnaire by 7:30 am each school day. Complete one form per student.

Por favor complete y envíe el siguiente cuestionario antes de las 7:30 am cada día escolar. Complete un formulario por alumno.

Veuillez remplir et soumettre le questionnaire suivant avant 7 h 30 chaque jour d'école. Remplissez un formulaire par étudiant.
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Student First Name *
Student Last Name *
Student Grade *
Student Temperature (please use a thermometer and list temperature in Fahrenheit) *
Since last in school, has the student had any of the following symptoms? Cough, shortness of breath, difficulty breathing, new loss of taste or smell, fever of 100.4 or higher, chills/shaking chills, muscle aches, headache, sore throat, nausea/vomiting, diarrhea, fatigue, congestion or runny nose *
Since last in school, is the student awaiting a COVID-19 test result, been diagnosed with COVID-19, or been instructed by any health care provider or the health department to isolate or quarantine? *
In the last 14 days , has the student had close contact (within 6 feet for at least 15 minutes) with anyone diagnosed with COVID-19 or suspected of having COVID-19 (i.e. tested due to symptoms)? *
In the last 14 days, has the student travelled outside of the United States? *
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