Elementary Student Screening Form
You must screen your child for COVID-19 every day before going to school/child care, after 5:00 a.m. each morning.

Your child must stay home if they have COVID-19 symptoms or are waiting for test results after experiencing symptoms. Everyone in your household must also stay home until your child gets a negative COVID-19 test result, or they are cleared by public health, or they are diagnosed with another illness.

Anyone who is sick or has any symptoms of illness, including those not listed in this screening tool, should stay home and seek assessment from their health care provider if needed.

This screening cannot diagnose you or your child. If you have medical questions, consult a health care provider or your local public health unit. Listen to the advice of your local public health unit first, as their advice overrules the advice in this screening.
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Student First Name: *
Student Last Name: *
Name of Parent/Guardian Completing Screening: *
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