COVID-19 Health Screening: Required Weekly

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

The health and well-being of our students, staff, and community starts with responsibly screening for symptoms of COVID-19 at home. If your child has signs of illness he or she SHOULD NOT report to school until all symptoms have cleared.

This form must be submitted by 8:00am on Monday morning. Students who do not have a cleared health screening on file each week will be quarantined in the campus nurse's office until a parent can be contacted.

Last Name *

First Name *

What grade level was your child in for the 2019-2020 school year? *

Parent Phone Number *

Has your child been in contact with anyone who has tested positive for the COVID-19 virus within the last 14 days? *

YES

Has your child had a fever over 100.0 in the last 24 hours or had any two or more of the following symptoms: cough, chills, repeated shaking with chills, muscle pain/aches, headache, sore throat, loss of taste or smell, or diarrhea? *

YES

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Bellville ISD. Report Abuse

Forms