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3rd Grade 20-21
Covid-19 Symptom Screening Questions
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* Indicates required question
Email
*
Your email
Today's Date
*
MM
/
DD
/
YYYY
Have you had any symptoms of (Check all that apply):
*
Sore throat
Vomiting
New or worsening cough
Difficulty breathing
a loss of smell/taste?
Fever/High Temperature
No Symptoms present
Required
Have you travelled out of state in the last 14 days?
Yes ( Please quarantine for 2 weeks)
No
Clear selection
Has your child tested positive for COVID in the last 2 weeks?
*
Yes
No
Have you been around anyone that has tested positive for COVID in the last 2 weeks?
*
Yes
No
Student Name and grade
*
Your answer
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