Health Screening
Please make sure to only mark "new" symptoms. Symptoms that are attributed to an existing conditions, such as allergies, should not be marked as "Yes". Please note that the second section of this questionnaire covers the practices that you, or your child, will follow when they are on campus. A response of "Yes" to any symptoms, or "No" to any onsite practices will result in refusal to campus entry.
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Student's First Name: *
Student's Last Name: *
Symptoms *
Do you have any of the following symptoms?
Yes
No
A new fever (100.0 or higher) or a sense of having a fever
A new cough that cannot be attributed to another health condition
New shortness of breath or difficulty breathing that cannot be attributed to another health condition
New chills that cannot be attributed to another health condition
A new sore throat that cannot be attributed to another health condition
New muscle aches (myalgia) that cannot be attributed to another health condition, or that may have been caused by a specific activity (such as physical exercise)
A new loss of taste or smell
Have had a positive test for the virus that causes COVID-19 disease within the past 10 days
In the past 14 days, have had close contact (within about 6 feet for 15 minutes or more) with someone with suspected or confirmed COVID-19
Have traveled internationally in the past 14 days
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