Daily COVID-19 Monitoring Sheet
Please fill out this monitoring form for all of your children attending in-person learning at Clover Garden PRIOR to coming on campus.  Please do not fill out this form before 5am.  The form should be filled out each day and individually for each child.  Thank you for helping all our Grizzlies stay safe and healthy!
Google에 로그인하여 진행상황을 저장하세요. 자세히 알아보기
Your Student's First and Last Name *
Your Student's Grade Level *
Has your child experienced any of the following symptoms in the past 48 hours?  Fever, cough, difficulty breathing, new onset of severe headache especially with a fever, new loss of taste or smell, sore throat, or vomiting, diarrhea. *
Within the past 14 days, has your child been in close physical contact (6 feet or closer for a cumulative total of 15 minutes) with anyone who is known to have laboratory-confirmed COVID-19? OR Anyone who has any symptoms consistent with COVID-19? *
Is your student isolating or quarantining because you have been exposed to a person with COVID-19 or are worried that you may be sick with COVID-19? *
Is your student currently waiting on the results of a COVID-19 test? *
Please initial if this statement is true:  I attest that the information on this form is true to the best of my knowledge. *
제출
양식 지우기
Google Forms를 통해 비밀번호를 제출하지 마세요.
이 설문지는 Clover Garden Charter School 내부에서 생성되었습니다. 악용사례 신고
Google 설문지