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OA - Student Symptom Check
Fill out form daily before you get to campus.
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Grade Level
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K
1
2
3
4
5
6
7
8
9
10
11
12
Phone Number
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Your answer
What is your temperature? **If your temperature is more is than 100.4 F, you may not be on campus.
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0 points
Your answer
Have you been exposed to someone with COVID-19 in the past 14 days?
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0 points
No
Maybe
Yes
Do you feel ill?
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0 points
Yes
No
Do you have any of the following symptoms that are unexplained? (check all that apply)
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1 point
Cough
Shortness of breath or difficulty breathing
Chills
Fatigue
Muscle or body aches
Congestion or runny nose
Sore throat
Headache
New loss of taste or smell
Nausea
Vomiting (unidentified cause, unrelated to anxiety or eating
Diarrhea
None
Other:
Required
Type your full name below to accept the following statement: I, ___________________, attest that the answers above are accurate to the best of my knowledge. I confirm that I have not been exposed to anyone with COVID-19 in the past 14 days.
*
1 point
Your answer
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