Revised Daily Health Screening Questions -March SACA
Please complete this screening form each day before arriving to school.  
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1. Is your child , or a household member currently waiting for the results of a COVID-19 test? *
2. In the past 10 days, Has your child experienced any symptoms of COVID-19 , including a fever of 100.0 F or greater, new cough, loss of taste or smell, shortness of breath, sore throat, headache, nasal congestion, runny nose (sniffles), stomach upset? *
3. In the past 10 days has your child gotten a lab confirmed positive COVID-19 test result (not  a blood test) that was their first positive COVID-19 result OR was 90 days from their previous positive COVID-19 result? Please note the 10 days is measured from the day you were tested, not the day you received the results. *
4. To the best of your knowledge , in the past 10 days has your child been in close contact (within 6 feet for at least 10 minutes over 24 hour period) with anyone who has tested positive for COVID -19 or who has been told they have symptoms of COVID-19 ? *
5. In the last 10 days has your child or a household member traveled internationally or traveled for longer than 24 hours other than to New Jersey, Pennsylvania, Connecticut, Massachusetts or Vermont? *
Student Name *
Student Class *
Parent Name *
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