STUDENT: COVID-19 Symptom Screening Questions

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COVID-19 Symptom Screening Questions for Hybrid/In-Person Learning Students Only
REVISED: January 15, 2021

Student’s First Name *

Student’s Last Name *

Grade Level *

6th Grade

7th Grade

8th Grade

In the last 10 days, have you tested positive for COVID-19 or are you waiting for results of a COVID-19 test? *

Yes

The CDC defines Close Contact as “any individual who was within 6 feet of an infected person for at least 15 minutes over a 24-hour period, starting from 2 days before illness onset (or, for asymptomatic patients, 2 days prior to positive specimen collection) until the time the patient is isolated.”

In the last 7 days, have you had Close Contact with anyone or live in the same household with anyone confirmed to have COVID-19 or waiting for results of a COVID-19 test? *

Yes

In the last 7 days, have you experienced, or are you currently experiencing, any new or unusual symptoms not experienced before as follows: *

a. Fever of 100.4° or greater orally, or 99.4° with SCCPSS adopted kiosk thermal and non-touch handheld thermometers

b. Feeling feverish (chills, sweating)

c. New cough

d. Shortness of breath or difficulty breathing

e. Fatigue

f. Headache

g. Muscle aches or body aches

h. New loss of taste or smell

i. Sore throat

j. Vomiting, diarrhea, or nausea

k. Congestion or runny nose

None of the above

Required

If you answered YES to any of these questions you cannot enter any district facility. Immediately advise your School Principal and do not report to the school building. Your School Principal will contact you for further review and return to school instructions.

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