Coronavirus COVID-19
Camden Street Student Health Screening
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Student Name *
Date *
MM
/
DD
/
YYYY
Homeroom Teacher and Room Number
Emergency Contact and Phone Number *
Do you currently have a fever of 100.4 degrees F or greater? *
In the past 14 days have you had any symptoms ? (Check all that applies) *
Required
In the past 14 days, have you gotten a positive result from a COVID-19 test that tested saliva or used a nose or throat swab? (not a blood test) *
Have you been in contact with an individual who has tested positive for Coronavirus in the last 24-hours? *
Are you returning from vacation? *
If yes, what state/country/territory did you visit? (must be checked against NJ travel restrictions list before entry)
Temperature Check *
Submit
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