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Divine Wisdom Catholic Academy
Health Screening for COVID-19
Parents, please fill this out this form if you plan on coming into the main office for ANY reason.
For Volunteers, fill out the form on the tablet on the security desk instead.
NOTE: This is NOT the health screening for in-person students.
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* Indicates required question
Email
*
Your answer
Your Name and/or Children
*
Your answer
Cell Phone Number with Area code
*
Example: 7186313153
Your answer
Reason for Visit
*
Your answer
Have you had a fever above 100.3 in the last 24 hours?
*
1 point
Yes
No
Are you exhibiting any of these symptoms? Fever, chills, shortness of breath, difficulty breathing, worsening cough, sore throat, diarrhea, nausea, vomiting, headache or loss of taste or smell
*
1 point
Yes
No
Is anyone in your household experiencing any of these symptoms? Fever, chills, shortness of breath, difficulty breathing, worsening cough, sore throat, diarrhea, nausea, vomiting, headache or loss of taste or smell
*
1 point
Yes
No
Have you been in close contact in the last 14 days with someone diagnosed with COVID-19?
*
1 point
Yes
No
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