STUDENT COVID SCREENING

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To be completed by parent/guardian daily

Email *

Child's Last Name / Apellido del niño: *

Child's First Name / Primero nombre del niño: *

Child's School / Escuela del niño *

PVES

PVMS

PVHS

Child's Grade Level / Grado del niño *

In the past two weeks have you traveled internationally? / ¿En las últimas dos semanas ha viajado internacionalmente ? *

https://coronavirus.health.ny.gov/covid-19-travel-advisory

Yes

Has your child had close or proximate (within 6ft for at least 10 minutes) contact with any person with known COVID-19 or person under Investigation for COVID-19? / ¿Su hijo ha tenido contacto cercano (dentro de los 6 pies durante al menos 10 minutos) con alguna persona con COVID-19 conocido o persona bajo Investigación por COVID-19? *

For more information on close or proximate information: https://www.buffalo.edu/content/dam/www/coronavirus/Contacts%20of%20Contacts%20Guidance%20DOH.pdf

Yes

Is your child's temperature at or above 100.0? (if it is then they must stay home) / ¿Su temperatura es igual o superior a 100,0? (si es así, debe quedarse en casa) *

Yes

Does your child have any symptoms of COVID-19? / ¿Su hijo tiene algún síntoma de COVID-19? *

https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/children/mis-c.html

Yes

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