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Student COVID-19 Screening
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* Indicates required question
Name
*
Your answer
The student’s recorded temperature within the last hour. If the student’s temperature is over 100.3 keep the student home today.
*
Your answer
Have you had a fever in the last 24 hours?
*
Choose
Yes
No
Are you currently on a fever reducing medication (Motrin, Tylenol, etc)?
*
Choose
Yes
No
Have you had contact* with a person with a suspected case of COVID-19? *Contact is defined as less than 6 feet separation for more than 10 minutes without adequate personal protective equipment in the last 10 days.
*
Choose
Yes
No
Have you had contact* with a person with a confirmed case of COVID-19? *Contact is defined as less than 6 feet separation for more than 10 minutes without adequate personal protective equipment in the last 14 days.
*
Choose
Yes
No
Have you been sick or not feeling well in the last 2-10 days with any of the symptoms listed below?
Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
Thank you for your response. If you answered YES to any question please stay home. It is recommended that you contact your personal physician or local Health Department.
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