COVID-19 Daily Student Questionnaire

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The Center for disease control and Prevention (CDC) recommends that we take extra precautions now that Marylanders are becoming sick with this virus however, in order to protect you and others, we would like to ask you a few questions regarding symptoms and travel.

Email *

Student Name *

Student Grade *

Have you or anyone in your household come into contact with anyone who has traveled outside of Maryland within the past 14 days? If you checked, yes, please, contact the school nurse at 410-719-0921 (ext 202) or via kinza.siddiqui@alrahmah.org *

Yes

Have you been in contact with someone who has been suspected, under investigation for, or with a confirmed case of COVID-19 (2019 Novel Coronavirus) within the past 14 days ? *

Yes

Do you, or anyone in your family currently have a fever, cough, body aches, rash, unrelievable headaches or has lost sense of smell or taste within the past 14 days? *

Yes

Have you been diagnosed with COVID or think you have COVID-19 within the past 14 days? *

Yes

Have you participated in any indoor SOCIAL/FAMILY gatherings of 10 people or more OUTSIDE of the school? *

Yes

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