COVID-19 Health Screening Questionnaire

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COVID-19 Health Screening Questions to be completed daily by a parent/guardian, staff member or visitor.

Staff and Students should remain at home if any of the responses are ‘YES.'

Visitors will not be permitted into FCPS facilities if any of the responses are ‘YES.'

Email *

Are you or anyone in your family feeling feverish and/or having chills –documented temperature of 100.4°F or higher? *

Yes

Have you or a family member used any fever reducing medication within the last 24 hours? *

Yes

Do you or a family member have a new cough that is not due to another health condition? *

Yes

Do you or a family member have a new shortness of breath or difficulty breathing that is not due to another health condition? *

Yes

Do you or a family member have any new chills that are not due to another health condition? *

Yes

Do you or a family member have a new sore throat that is not due to another health condition? *

Yes

Do you or a family member have any new muscle aches that are not due to another health condition, or that may have been caused by a specific activity (such as physical exercise)? *

Yes

Have you or a family member had a new loss of taste or smell? *

Yes

Have you or a family member had a positive test for the virus that causes COVID-19 disease within the past 10 days? *

Yes

In the past 14 days, have you or a family member had close contact (within about 6 feet for 15 minutes or more) with someone with suspected or confirmed COVID-19? *

Yes

Send me a copy of my responses.

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