JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Coronavirus Screening for the 2021-2022 Academic Year
The safety of our school community is our overriding priority. As the coronavirus (COVID-19) pandemic continues, we are monitoring the situation closely and following the guidance from the Archdiocese of St. Louis and the St. Louis City Department of Health. In order to prevent the spread of the coronavirus and reduce the potential risk of exposure to our school community, we are asking everyone to complete and submit this questionnaire prior to entering the school each day.
Please respond to each of the following questions truthfully and to the best of your ability.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Family Last Name
*
Your answer
Do you have a fever of 100.4 or higher?
*
Yes
No
Have you come into contact with someone who has been diagnosed with Coronavirus (COVID-19) in the past 14 days?
*
Yes
No
Are you showing any of the following symptoms: cold/flu like symptoms, new or worsening coughing, new or worsening shortness of breath, sore throat, nausea, body aches, lost of taste or smell, or diarrhea?
*
Yes
No
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Saint Raphael the Archangel School.
Report Abuse
Forms