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Corrine's T/Th/F 3's - Daily COVID19 Symptom Check In
Please fill out this form before every class. If you answer "YES" to any of the following questions STAY HOME and contact the school.
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* Indicates required question
Student's First and Last Name
*
Your answer
Drop Off Contact Name
*
Your answer
Drop Off Contact Phone Number
*
Your answer
Has your child or anyone in your household had any of the following symptoms that are not caused by another condition in the past 24 hours?
*
Fever 100.4 F/ 38 C
Cough
Shortness of Breath or Difficulty Breathing
Chills
Fatigue
Muscle Pain or Body Aches
Headache
New Loss of Taste or Smell
Sore Throat
Runny Nose or Congestion
Nausea/Vomiting
Diarrhea
Other signs of new illness that are unrelated to a preexisting condition (such as season allergies)
None of the above
Required
If you check any of the boxes in the previous question, who has these symptoms in your household?
Student
Sibling
Parent
Other:
Has your child been in close contact with anyone with confirmed or suspected COVID-19? Close contact means being within 6 feet of an infected person for 15 minutes or more.
*
Yes
No
Has your child had a positive COVID-19 test for active virus in the past 10 days?
*
Yes
No
Within the past 14 days, has a public health or medical professional told your child to self-monitor, self-isolate, or self-quarantine because of concerns about COVID-19?
*
Yes
No
Has your child had any medication to reduce a fever today?
*
Yes
No
Today's Temperature (Will be rechecked by BB Staff)
*
Your answer
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