COVID-19 Daily Symptom Checker for Students

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Dear Parents, Guardians, Caregivers
The San Joaquin County Public Health Officer and the California Department of Public Health (CDPH), are requiring that students check their symptoms daily for COVID-19 before coming to school. This form must be complete whether your child has symptoms or not. The symptom checker must be completed every morning before your child comes to school, rides the bus and/or comes on school campus.

Under the order of the San Joaquin County Public Health Officer and CDPH:

• If your child has tested COVID-19 positive, they must isolate at home for 10 days after symptoms first appeared and until they are fever-free for 24 hours without fever-reducing medication and there is an improvement in their symptoms. If your child has been diagnosed with COVID-19 and has no symptoms (asymptomatic), they must stay home for 10 days from the date of their positive COVID-19 test.

• If your child has had close contact, less than 6 feet for 15 minutes or more, with someone who is COVID-19 positive or has been told by a health care provider to get tested for COVID-19, they must quarantine (stay home) for 14 days from his/her last exposure to the COVID -19 positive person.

• If your child has signs and symptoms of COVID-19, but tests negative for COVID-19 and has had no known exposure to someone COVID-19 positive, they may return to school 3 days after symptoms improve.

In any of the situations above or if you are unsure, please keep your child home and contact your school nurse or school site.

Email *

Students First and Last Name *

Phone Number *

Student's school site? *

Name of student's teacher/Teacher of Record *

Is your child feeling ill? *

Yes

Does your child have any of the following symptoms? (Check all that apply.) *

Temperature of 100.4 degrees or higher

Shortness of breath or difficulty breathing (unexplained)

Cough (unexplained and unrelated to existing seasonal allergies or underlying chronic condition)

Runny nose or congestion (unexplained and unrelated to existing seasonal allergies or underlying chronic condition)

Chills or uncontrollable body shaking with chills

Fatigue (unexplained)

Headache, muscle aches, or body aches (unexplained)

New loss of taste or smell

Nausea or vomiting (unexplained)

Diarrhea (unexplained)

Sore Throat

I have no COVID-19 symptoms

Required

Has your child been diagnosed with COVID-19 or asked by a health care provider to be tested for COVID-19 in the past 14 days? *

Yes

Has your child been in close contact (less than 6 feet for 15 minutes or more) with someone who has been diagnosed with COVID-19 or someone who has been told by a health care provider to be tested for COVID-19 in the past 14 days? *

Yes

If you indicated YES to any of the above questions, keep your child home and report his or her absence to the school. You may consider contacting your child's health care provider. Thank you for completing this questionnaire.

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