JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
DAT Daily Symptom Screening
Please answer the following questions on a daily basis prior to morning drop off.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Family Name:
*
Your answer
1st Student- Name:
*
Your answer
Student Grade:
*
Choose
K
1
2
3
4
5
6
7
8
9
10
11
12
Does your child have, or has your child recently had, a temperature of 100.4°F or higher?
*
Yes
No
Required
Does your child have, or has your child recently had, any of the following symptoms? Please check "yes" or "no" to the following:
*
Yes
No
Cough
Shortness of Breath/Difficulty Breathing
Chills
Muscle Aches
Sore Throat
New loss of taste or smell
Exposure to someone with COVID-19 or similar symptoms
Fever between 99.2 but below 100.3
Anyone in your household with a temp above 100.4 ?
Yes
No
Cough
Shortness of Breath/Difficulty Breathing
Chills
Muscle Aches
Sore Throat
New loss of taste or smell
Exposure to someone with COVID-19 or similar symptoms
Fever between 99.2 but below 100.3
Anyone in your household with a temp above 100.4 ?
If you answered "yes" to any of the above, please describe the nature of the symptoms:
Your answer
Do you have more children attending DAT?
*
Yes
No
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Denver Academy of Torah.
Report Abuse
Forms
