ACDS COVID-19 Self Screening Questionnaire
  • ACDS COVID-19 Self Screening Questionnaire

  • I certify that as of this morning:

    • My ACDS students have been fever-free for at least 24 hours without medication.
    • If I have unvaccinated or partically vaccinated ACDS students:
      • They are not under quarantine due to close-contact with someone who has COVID-19
      • They have not been in close-contact with someone who is suspected to have COVID-19  in the last 14 days and is awaiting their test results. 
      • They have not engaged in high-risk activities in the last 10 days including attending large indoor events, traveling by airplane, bus or train, been on a cruise ship, or been to a location where it was not possible to maintain distance from people with moderate/high or unknown exposure risk.
      • No one in our household currently has any symptoms consistent with COVID-19 including fever, chills or sweating, new or worsening cough, sore throat, runny nose/congestion, chest pain or pressure, aching throughout the body (not related to an injury), vomiting or diarrhea, loss of taste or smell, other lower respiratory symptoms, or aches and pain that are new or unusual.*

    • If I have fully vaccinated ACDS students:
      • They do not have any symptoms consistent with COVID-19 including fever, chills or sweating, new or worsening cough, sore throat, runny nose/congestion, chest pain or pressure, aching throughout the body (not related to an injury), vomiting or diarrhea, loss of taste or smell, other lower respiratory symptoms, or aches and pain that are new or unusual.*
      • If they have been identified as a close contact or have engaged in high-risk activities, I have notified their Division Head and will have them tested in accordance with the school's policy.
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  • If you cannot make this certification, please keep your children home and contact your division head.

  • *Symptoms that are also common for other illnesses that are known to be caused by a chronic condition such as allergies or asthma, or that have been diagnosed by a physician as something other than COVID-19 are exempt. 

  • Should be Empty: