CSSM COVID-19 Student Screening - 聖瑪利諾中文學校學生新冠病毒篩檢紀錄
Screenings are conducted before students may enter CSSM summer school campus at Carver Elementary School. These screening can be done remotely or in-person upon arrival. One submission per day.

如果學生預計當天會進入中文學校暑期班位於Carver小學的校園，必須提交篩檢紀錄。篩檢可以在遠端或現場到達再完成，一天提交一次即可，謝謝您的理解及配合。
Sign in to Google to save your progress. Learn more
Student's full name 學生的姓名 *
Do you have a cough? 請問您有過咳嗽的症狀嗎? *
Do you have a shortness of breath?  請問您有過呼吸困難? *
Do you have fever or chills? 請問您有感覺發燒或是發冷嗎? *
Body temperature is greater than or equal to 100.4°F or 38°C 身體溫度達到華氏100.4度/攝氏38度或以上
Have you had close contact with an individual who has screened positive or known to be infected for COVID-19 in the last 14 days? 請問您過去14天內接觸過任何新冠病毒測試陽性的患者或是被感染過嗎? *
Have you traveled outside of California in the last 10 days? 請問您過去十天內有過旅行出過加州的紀錄嗎? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms