Buena Vista Graduation Practice and Ceremony Daily COVID-19 Self-Assessment

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Please complete this electronic form DAILY before reporting to graduation practice or the graduation ceremony.

If you are sick or experiencing any symptoms, DO NOT REPORT TO THE FIELD.

Last Name *

First Name *

Have you had any of the following symptoms:

Please check yes or no to following questions:

Fever/Chills *

Yes

Option 4

Option 3

Sore Throat *

Yes

Option 3

New Loss of Taste or Smell *

Yes

Headache *

Yes

Body Ache *

Yes

Fatigue *

Yes

Nausea, Diarrhea, Vomiting *

Yes

Cough *

Yes

Shortness of Breath *

Yes

Difficulty Breathing Today *

Yes

Have you taken fever-reducing medicines while having a fever in the last 24 hours? *

Yes

To the best of your knowledge, have you been exposed to anyone tested for confirmed Corona Virus? *

Yes

To the best of your knowledge, have you been around anyone with Corona Virus symptoms? *

Yes

If you have answered YES to any of the questions, DO NOT report to the ceremony. Please contact the school for any questions at (562) 602 - 8090.

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