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21-22 Student Daily COVID-19 Symptom Screening
This form is required to be completed honestly before entering a building on campus each school day - do NOT complete the form the night before. A Scecina staff member must verify daily submission of this form before admittance is permitted to a building on campus each school day as well as on non-school days, when the student is participating in an extra-curricular activity, occurring on or off campus. Scecina requires the use of a face mask for unvaccinated and vaccinated staff and students. Scecina will provide a face mask, if the student does not have one.
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Symptom Screening
Are you (Scecina student) showing any signs of the illnesses listed here: Fever (100.4 or Chills), Sore Throat, New Cough or Shortness of Breath, Diarrhea, Nausea, Vomiting, Abdominal Pain, New Headache, New Loss of Taste or Smell?
*
Yes
No
Have you (Scecina Student) been in close contact (within 6 feet for more than 15 minutes) with anyone confirmed with COVID-19 within the last 24 hours?
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Yes
No
Conclusion
If the Scecina student selected "Yes" to either of the two questions above, the student must stay home/return home from all school activities and receive guidance from the front office on next steps. Please contact the front office and indicate the situation by calling 317-356-6377 and provide the following information: student first and last name, date that symptoms started, and a good contact phone number to reach a parent to call back if needed.
A copy of your responses will be emailed to the address you provided.
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