COVID-19 Questionnaire - Weekly Screener

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Please complete this mandatory questionnaire by Monday at 12:00PM each week.

Child's First Name: *

Child's Last Name: *

Today's date *

YYYY

My child's building is:

Jamesville DeWitt High School

Jamesville DeWitt Middle School

Jamesville Elementary

Moses DeWitt Elementary

Tecumseh Elementary

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In the last 10 days... has your child been designated a contact of someone who has tested positive for COVID-19? Been notified by your medical provider or a local government official to remain home because of COVID-19? Tested positive for COVID-19? Had a fever of 100.0 or greater now or in the last 10 days? Has your child travelled internationally? *

No to all of these questions

Yes to one or more of these questions

Required

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