Pawling High School COVID-19 Screening Questionnaire
This form is completed digitally by Parents/Guardians of students who are coming to school on campus. / Este formulario lo completan digitalmente los padres / tutores de los estudiantes que vienen a la escuela en el campus.
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Email *
Student First Name / Primer nombre del estudiante *
Student Last Name / Apellido del estudiante *
Do any of the following statements apply to you? I have had COVID-19 symptoms in the past 14 days (current CDC defined symptoms include cough, shortness of breath, or at least two of the following symptoms: fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste and smell). I have had a positive COVID-19 test in the past 14 days. I have NOT BEEN VACCINATED MORE THAN TWO WEEKS AGO OR HAVE PREVIOUSLY HAD COVID-19 WITHIN THE LAST 90 DAYS AND had close contact with confirmed COVID-19 cases in the past 10 days.                                                   ¿Alguna de las siguientes afirmaciones se aplica a usted? He tenido síntomas de COVID-19 en los últimos 14 días (los síntomas actuales definidos por los CDC incluyen tos, dificultad para respirar o al menos dos de los siguientes síntomas: fiebre, escalofríos, temblores repetidos con escalofríos, dolor muscular, dolor de cabeza, dolor de garganta, o nueva pérdida del gusto y el olfato). Tuve una prueba de COVID-19 positiva en los últimos 14 días. NO HE SIDO VACUNADA HACE MÁS DE DOS SEMANAS O HE TENIDO COVID-19 EN LOS ÚLTIMOS 90 DÍAS Y he tenido contacto cercano con casos confirmados de COVID-19 en los últimos 10 días. *
If you answered “Yes” to the question, do not report to school, and immediately contact your school nurse (koernerb@pcsdny.org).  /  Si respondió “Sí” a la pregunta, no se presente a la escuela y comuníquese inmediatamente con la enfermera de su escuela (koernerb@pcsdny.org).
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