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Health screening SAP 2021-22
Covid-19 Symptom Screening Questions
(cite source:
https://www.cdc.gov/screening/paper-version.pdf
)
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* Indicates required question
Students Name Last name first
*
Your answer
Grade level
*
Kinder
1st
2nd
3rd
4th
5th
6th
7th
8th
Other:
Required
Have you had any symptoms of (Check all that apply):
*
Sore throat
Vomiting
Headaches
Body aches
New or worsening cough
Muscle pain
Difficulty breathing
a loss of smell/taste?
Fever/High Temperature
No Symptoms present
Required
Have you had COVID in the last 14 days?
*
Yes
No
Have you been around anyone that has tested positive for COVID in the last 2 weeks?
*
Yes
No
Have you traveled out state and or country? (note: If yes, please provide a negative covid test prior to returning on campus)
*
Yes
No
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