MVLA COVID-19 Health Check-In Survey
COVID Health Classroom Check-In Survey

In order to maintain a safe learning environment, students and staff members are REQUIRED to take their temperature at home and fill out this form every time they report to the campus.  You are also required to wear a protective face covering and observe social distancing guidelines.  

If you are feeling ill, PLEASE STAY HOME!  

If you respond YES to any of the questions below, please stay home.

Your email address will be recorded when you submit this form.
Увійдіть в обліковий запис Google, щоб зберегти надані відповіді. Докладніше
Your email address *
Last name, First name *
Date at school *
ДД
.
ММ
.
РРРР
Classroom Number
I am a... *
When I took my temperature TODAY it was OVER 100.4F *
Have you experienced COVID-19 symptoms within the past 14 days (such as persistent cough, fever in excess of 100.4 degrees, chills, sore throat, shortness of breath, diarrhea, the new loss of smell or taste, muscle pain)? *
Have you had close contact (within six feet) with anyone with a confirmed case of COVID-19 or any other communicable disease in the past 14 days? *
Have you traveled outside the USA in the past 14 days? *
Надіслати
Очистити форму
Ніколи не вказуйте паролі в Google Формах.
Цю форму створено в домені Mountain View Los Altos High School District. Повідомити про порушення
Google Форми