Field Attendance

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Field Attendance

INSTRUCTIONS: Please complete a form for EACH student in your household who is absent. Please complete a form for each separate student illness.

Student Name *

Student ID (if known)

Today's Date

YYYY

Which school does your student attend? *

What grade? *

Date of Birth *

YYYY

What are your student’s symptoms that caused his/her absence today? Check ALL that apply . *

Fever of 100.4 or higher

Sore throat

Cough

Shortness of breath

Body aches/chills

Fatigue

Congestion

Headache

Asthma related symptoms

Nausea

Diarrhea

Vomiting

Rash

Mental health related concern

Exposure to a person suspected/ positive for COVID-19

Other illness/injury

Other (appointment, vacation, family, etc)

Required

If you selected other illness/injury, please describe here:

If your student is out ill, please share when the symptoms first began?

YYYY

If your student is out ill, have you isolated them?

Under health care provider or health department orders

Self isolation due to symptoms and possible exposure to COVID-19

Self isolation due to exposure to a potential positive COVID-19 case

Not isolated

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