3K January Student Daily Health Screening
Please complete and submit every morning before 8:30 AM
Sign in to Google to save your progress. Learn more
Email *
3K Student Name
Does your child have any of the following symptoms, that indicates a possible illness that may decrease the student’s ability to learn and also put them at risk for spreading illness to others? · Temperature 100.4 degrees Fahrenheit · Sore Throat *New uncontrolled cough that causes difficulty breathing (for students with chronic allergic/asthmatic cough, a change in their cough from baseline) · Diarrhea, vomiting, or abdominal pain · New onset of severe headache, especially with a fever · Shortness of breath · Fatigue · Muscle or body aches · New loss of taste or smell · Congestion or runny nose · Nausea or vomiting · Diarrhea *
To the best of your knowledge, in the past 14 days, has your child been in close contact (within 6 feet for at least 10 minutes) with anyone who has tested positive through a diagnostic test for COVID-19 or who has or had symptoms of COVID-19? *
Has your child or a member of your household traveled internationally or from a state with widespread community transmission of COVID-19 per the New York State Travel Advisory in the past 14 days * *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Holy Child Jesus Catholic Academy. Report Abuse