OFS Arbor COVID-19 Health Screening

OFS Arbor COVID-19 Health Screening

This health screening must be completed prior to attending Oneness Family School today. It is critically important that everyone at school is healthy and symptom free. Anyone with a current temp of 100.4 or greater may not be admitted to the center. Students must meet all these conditions in order to be admitted to the center.
Student's Name *

First Name Last Name
Person Filling Out Form *
DateTime
Pod
Student's Temperature *
Has this student taken any fever-reducing medications like acetaminophen or ibuprofen in the past 24 hours? *

Yes No
Symptoms

Is this student currently experiencing any of these symptoms or have you experienced any of these symptoms in the last 24 hours? **If you answer yes to any of these symptoms, please speak with a school administrator.
Cough, shortness of breath, fever of 100.4 or higher, chills, shivering, muscle pain, sore throat, headache, loss of sense of taste or smell, and gastrointestinal symptoms (nausea, vomiting, or diarrhea): *

Yes No
Does this student have symptoms of other communicable illnesses? *

Yes No
Are there any health concerns that would prevent this student from engaging in daily activities including outdoor play? *

Yes No
COVID 19 Test Results and Contact with Person Diagnosed with COVID-19
Is this student waiting for a COVID-19 test result, diagnosed with COVID 19, or instructed by any health care provider or the health department to isolate or quarantine? *

Yes No
In the last 14 days, has this student had close contact (within 6 feet for 15 minutes) with anyone diagnosed with COVID-19 or suspected to have COVID-19? *

Yes No
Should be Empty:

OFS Arbor COVID-19 Health Screening

Symptoms

COVID 19 Test Results and Contact with Person Diagnosed with COVID-19