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COVID-19 Daily Questionnaire
Please complete this COVID-19 questionnaire before arriving to school each day. If yes is answered to any of the following questions, you will need to be cleared by a physician to return.
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* Indicates required question
First Name
*
Your answer
Student Last Name
*
Your answer
Select your Grade Level
*
Choose
6
7
8
9
10
11
12
Have you been exposed to an individual that has tested positive with COVID? If yes, you must be cleared by a physician to return.
*
Yes
No
Have you traveled internationally or to a heavily impacted zone within the US in the last 14 days?
*
Yes
No
If yes, where:
Your answer
Have you experienced a fever, chills, breathing difficulty, loss of taste or smell, fatigue, nausea, vomiting, headache, or diarrhea?
*
Yes
No
If yes, explain:
Your answer
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