Covid-19 Health Screening

Covid-19 Health Screening

Please fill out one screening per student daily
FORM IS NOW CLOSED

IT WILL RE-OPEN TOMORROW AT 5AM.

Form is open from 5am-12pm daily, please have your results screen or email ready to show facutly/staff upon arrival.
Student Name *

First Name Last Name
Date *

Month Day Year
Date
Parent Email *
example@example.com
Have you administered fever reducing medication to your child in the last 24 hours? *

Yes No
Does your child have a fever? *

Yes No
Was your child's temperature greater than 100.4? *

Yes No
New loss of taste or smell? *

Yes No
Chills or sweating? *

Yes No
Has your child been exposed to anyone with Covid-19? *

Yes No
Have you travelled out of state within the past 7 days? *

Yes No
Time

: Hour Minutes AM/PM Option
Should be Empty: