3K April Student Daily Health Screening
Please complete and submit every morning before 8:30 AM
Sign in to Google to save your progress. Learn more
Email *
3K Student Name *
1. Is your child , or a household member currently waiting for the results of a COVID-19 test?
Clear selection
 2. In the past 10 days, Has your child experienced any symptoms of COVID-19 , including a fever of 100.0 F or greater, new cough, loss of taste or smell, shortness of breath, sore throat, headache, nasal congestion, runny nose (sniffles), stomach upset? *
3. In the past 10 days has your child gotten a lab confirmed positive COVID-19 test result (not  a blood test) that was their first positive COVID-19 result OR was 90 days from their previous positive COVID-19 result? Please note the 10 days is measured from the day you were tested, not the day you received the results. *
4. To the best of your knowledge , in the past 10 days has your child been in close contact (within 6 feet for at least 10 minutes over 24 hour period) with anyone who has tested positive for COVID -19 or who has been told they have symptoms of COVID-19 ? *
5. In the past 10 days has your child or a household member returned from an international destination?
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Holy Child Jesus Catholic Academy. Report Abuse
Google Forms