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Daily COVID-19 Monitoring Sheet
Please fill out this monitoring form for all of your children attending in-person learning at Clover Garden PRIOR to coming on campus. Please do not fill out this form before 5am. The form should be filled out each day and individually for each child. Thank you for helping all our Grizzlies stay safe and healthy!
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Your Student's First and Last Name
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Your answer
Your Student's Grade Level
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Kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
Middle School
High School
Has your child experienced any of the following symptoms in the past 48 hours? Fever, cough, difficulty breathing, new onset of severe headache especially with a fever, new loss of taste or smell, sore throat, or vomiting, diarrhea.
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Yes
No
Within the past 14 days, has your child been in close physical contact (6 feet or closer for a cumulative total of 15 minutes) with anyone who is known to have laboratory-confirmed COVID-19? OR Anyone who has any symptoms consistent with COVID-19?
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Yes
No
Is your student isolating or quarantining because you have been exposed to a person with COVID-19 or are worried that you may be sick with COVID-19?
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Yes
No
Is your student currently waiting on the results of a COVID-19 test?
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Yes
No
Please initial if this statement is true: I attest that the information on this form is true to the best of my knowledge.
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Your answer
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