COVID-19 Screening Survey

At present, this form is required to be completed by EVERY individual student and on every day they are attending school on-campus. It is important that the form be submitted PRIOR to getting on a school bus or coming onto campus. We suggest that you secure a thermometer and set up a morning routine that allows time to complete a form per student in a family. If you have questions or a problem completing the form please contact your building nurse.

*Contact Type:

Contact ID:

(optional)

*First Name:

*Last Name:

*Phone Number:

*Email:

*Confirmation Email:

*School:

In the past 10 days: Have you had any symptoms of COVID-19? (Fever, rash, chills, cough, shortness of breath/difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting/diarrhea).

In the past 10 days: Have you tested positive for COVID-19?

In the past 10 days, have you had close contact with a confirmed or suspected COVID-19 case?

Have you traveled internationally or to any state that will require you to quarantine, in the last 10 days?

Was your temperature over 100 degrees F. this morning? If "YES" please contact your health care provider and the nurse of your building. Do Not report to school.

Are you experiencing any of the symptoms or scenarios above? NoYes