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SHCA PK 4 Daily Health Screening Form
Please fill out the form below Daily. If you answer "Yes" to any of the following questions you cannot come in to school. Each child who is a student at Sacred Heart must fill one out. Please do so before 7:00 am
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* Indicates required question
Student Name
*
Your answer
Student Class
*
Choose
Mrs. Cosgrove
Does your child have a fever of 100.0 F?
*
No, Go to the next question.
Yes, No further screening is needed. Your child may not attend school.
Please Check One
No, Go to the next question.
Yes, No further screening is needed. Your child may not attend school.
Please Check One
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?
*
No. Go to the next questions.
Yes, No further screening is needed. Your child may not attend school.
Please Check One
No. Go to the next questions.
Yes, No further screening is needed. Your child may not attend school.
Please Check One
Has anyone in your family 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?
*
No. Go to the next questions.
Yes, No further screening is needed. Your child may not attend school.
Please Check One
No. Go to the next questions.
Yes, No further screening is needed. Your child may not attend school.
Please Check One
If so, how many days since exposure?
Your answer
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