Revised Daily Health Screening

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Revised Daily Health Screening - Student

This Revised Daily Health Screening is required to be completed each Sunday morning before entrance to religious education.

If you answer any of the questions with a "Yes" then you may not go to school.
If you answer all questions with a "No" then you may go to school.

Please submit the completed form on Sunday mornings by 9am before bringing your child to class.

Thank you for your cooperation.

This form is updated September 24, 2021.

Email *

Student/s Name and Class Level *

Parent's Name *

Date Today *

YYYY

1. In the past 10 days, Has your child experienced any symptoms of COVID-19, including a fever of 100.0 F or greater, new cough, loss of taste or smell, shortness of breath, sore throat, headache, nasal congestion, runny nose (sniffles), stomach upset? *

Yes

2. In the past 10 days has your child gotten a lab confirmed positive COVID-19 test result (not a blood test) that was their first positive COVID-19 OR was 90 days from their previous positive COVID-19 result? Please note the 10 days is measured from the day you were tested, not the day you received the results. *

Yes

3. To the best of your knowledge, in the past 10 days has your child been in close contact (within 6 feet for at least 10 minutes over 24-hour period) with anyone who has tested positive for COVID-19 or who has been told they have symptoms of COVID-19? *

Yes

4. In the past 10 days has your child or a household member returned from an international destination? *

Yes

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