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HCISD Student COVID-19 Pre-screening Form
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* Indicates required question
Email
*
Your email
Student's First and Last Name
*
Your answer
Parent's First and Last Name
*
Your answer
Best phone number to reach parent.
*
Your answer
Has your student had a fever of 100.4 or higher during the past week?
*
Yes
No
Has your student been coughing or had unusual shortness of breath?
*
Yes
No
If you answered yes to any of the questions above? Has your student been tested for COVID-19 and what was the result of that test?
*
Yes - Negative
Yes - Positive
No - Have not been tested
I did NOT answer yes above.
Have you or your student traveled to a country with a CDC level 3 warning (
https://wwwnc.cdc.gov/travel/notices
) China, Iran, South Korea, Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, Switzerland, Monaco, San Marino, Vatican City
*
Yes
No
Have you or your student been exposed to anyone who has tested positive for COVID-19?
*
Yes
No
If you answered "No" to all questions, we look forward to seeing your student at school on Monday! If you answered yes, we will be in touch (using the phone number and/or email address provided above).
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