PPLP COVID Daily Screening Check
Students, Parents, and Guardians need to complete this screening BEFORE entering the SMTD building each day. Thank you for your cooperation as we keep our community members safe.
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Your Name *
You only need to fill out one form, even if you have multiple children entering the building today (unless multiple children have different answers).
Has your child(ren) or anyone in your household had Fever (over 100.4°F or 38°C), Feeling feverish, New shortness of breath, or New cough? *
Has your child(ren) had Nausea/vomiting or diarrhea, Sore throat, or Sudden onset of headache? *
Has your child(ren) or anyone in your household had TWO or more of any of these symptoms: Chills, Muscle aches, Nausea or vomiting, New nasal congestion (runny nose) or sore throat, New loss of sense of smell or sense of taste, New headache, New diarrhea or New rash? *
Has your child(ren) or anyone in your household had close or household contact in the last 14 days with someone diagnosed with COVID-19? *
Close contact is being within 6 feet of an infected person for a cumulative time of 15 minutes over a 24 hour period.If your close contact is through providing clinical care for COVID patients at Michigan Medicine or other health system while following appropriate protocols, answer NO.
Has your child(ren) or an UNVACCINATED member of your household traveled internationally in the past 7 days? *
If OHS has given you permission to return to work or school, answer NO.
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