Daily Wellness Questionnaire for Japhet School Attendance

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Between 6 AM and 8 AM Monday-Friday, a parent or designated adult guardian must fill out this form before coming to school (or before entering Before-school Care). The results will be read by a Japhet School faculty or staff member, bound by a confidentiality agreement.

Systematic reporting is paramount for the safety and well-being of all students, faculty, and staff. Please take the time to answer these questions carefully and accurately.

Your email address and today's date and time are automatically captured by this survey.

Email *

What is the day?

Monday

Tuesday

Wednesday

Thursday

Friday

Clear selection

What is your child's LAST name? (one form per child) *

What is your child's FIRST name? *

What is your child's class? *

A - Preschool

B - Kindergarten

C - Primary Class

D - Middle Class

E - Intermediate Class

F - Upper Class

Will your child attend school today? *

Yes. My child is healthy and will attend school.

No. My child does not feel well and is staying home. (Explain in the next question.)

No. My child may have been exposed to COVID-19. (Explain in the next question.)

No. We are traveling or staying home for other reasons not related to health. (Explain in the next question.)

If your child is staying home today for any reason, explain.

The mask my child is wearing today has been sterilized since its last use, or is a brand-new mask. *

Yes

No; my child needs a school-issued mask today (please minimize; Japhet supplies are limited).

N/A; not attending school

What was your child's temperature this morning? Answer digitally as XX.X (even if absent). *

Does your child have any of these new, unexplained symptoms? If you answer YES to any of these questions, please stay home and contact your healthcare provider. Contact the school for re-entry qualifications. *

Yes

Cough

Shortness of breath

Sore throat

Loss of taste or smell

Diarrhea

Nausea

Vomiting

Rash

Congestion

Has your child or anyone in your immediate household been exposed to someone diagnosed with COVID-19 in the last 14 days? If the answer is YES, please stay home and contact the school for re-entry qualifications. *

Yes

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