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AYLA Health Check-In for 05/02/21
WELCOME! Please answer the following questions about your health today
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* Indicates required question
Email
*
Your email
STUDENT Name (first & last)
*
Your answer
PARENT Name (first & last)
Your answer
PARENT email
Your answer
PARENT phone number
Your answer
Are you experiencing any of the following symptoms. Check NO SYMPTOMS if none apply.
*
Elevated temperature (>100°F)
Cough
Shortness of breakth, difficulty breathing
Fatigue
Chills, muscle or body aches
Sore throat
congestion or runny nose
Nausea, vomiting, diarrhea or other gastrointestinal disease
Headache
New loss of taste or smell
NO SYMPTOMS TODAY
Other:
Required
Do you have any other COVID -19 symptoms, positive test results or potential exposure to COVID?
*
NO COVID symptoms or potential exposure
YES
Have you travelled outside the STATE in the last 14 days?
*
Yes
No
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