Covid19 Student Daily Wellness

Covid19 Student Daily Wellness

• Screening questions must be completed daily before entering the school. • The form may be completed at home.
Student Name *

Last NameFirst Name
Student Grade*
If the answer to any of the below questions is “Yes” you may not report to school today. You must call the school office (305) 238-7562 for further instructions before bringing your child to school.
Within the last three (3) days, have you experienced any
of the following symptoms?
1. Fever or Chills?*

YesNo
2. New uncontrolled cough?*

YesNo
3. Shortness of breath or difficulty breathing?*

YesNo
4. Fatigue, muscle or body aches?*

YesNo
5. New onset of severe headaches?*

YesNo
6. New loss of taste or smell?*

YesNo
7. Congestion or runny nose?*

YesNo
8. Diarrhea, vomiting or abdominal pain?*

YesNo
9. Have you had a fever of 100.4 degrees F or greater (when taken by mouth) in the last three (3) days?*

YesNo
10. Have you had close contact (within six (6) feet of an infected person for at least 15 minutes) with a person who has tested positive for COVID-19?*

YesNo
11. Have you traveled outside of south Florida in the past week?*

YesNo
Date

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