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COVID-19: Screening Questionnaire for Students and Families
Student well-being and safety are of the utmost concern here at Oxford Academy and Central Schools. Monitoring the health and well being of our student is a requirement by the New York State Department of Health. Please fill out this weekly form to alert and disclose any health concerns to OXAC. Information will be used to ensure the safety and well being of everyone in the district. Please send this in by Monday morning. Thank you in advance for your attention and help with this matter.
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Student Name(s) - First and Last Name
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Your answer
Has this student had any of the following COVID-19 symptoms in the past 14 days? (i.e. - Fever, sore throat, chills, cough, nausea, diarrhea, muscle pain, shortness or difficulty breathing, new loss of taste or smell, headache, vomiting)
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Yes
No
Has this student traveled outside of NY State within the last 14 days?
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Yes
No
Has this student had a positive diagnostic COVID-19 test in the past 14 days?
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Yes
No
In the past 14 days have this student been in close contact or proximity with another person who tested positive for, or is suspected of having COVID-19?
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Yes
No
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