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MPCS COVID - 19 Student Daily Checklist
If you reply YES to any of these symptoms please notify the school immediately.
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* Indicates required question
Student's First and Last Name:
*
Your answer
Do your child have a fever?
*
Yes
No
Is your child's temperature above 100.4?
*
Yes
No
Has your child lost sense of taste or smell?
*
Yes
No
Muscle Ache?
*
Yes
No
Throat sore?
*
Yes
No
Cough?
*
Yes
No
Shortness of Breath?
*
Yes
No
Chills?
*
Yes
No
Headache?
*
Yes
No
Nasal congestion?
*
Yes
No
Fatigue?
*
Yes
No
Has your child experienced any GI symptoms such as nausea/vomiting/diarrhea/loss of appetite?
*
Yes
No
Has your child or anyone you have been in close contact with been diagnosed with COVID-19 or been placed in quarantine for possible contact with COVID-19?
*
Yes
No
Has your child or someone that you have been in contact with traveled to a State that is on the travel advisory list for NJ?
*
Yes
No
Statement
*
I acknowledge that I have completed the student assessment and I have answered all the questions to the best of my ability.
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