Holy Trinity Day School Daily Health Screening
Each family is required to fill out this form prior to 8:30 AM on the days your child(ren) attend school and present the email confirmation upon drop off.
Child(ren)'s Name(s) (ex: Joe & Susie Jones)
My child(ren)'s temperature today is: (For multiple children list in the same order as names above)
Please answer each question
In the last 14 days, has your child or anyone in your household been in close contact (within 6 feet for more than 15 min.) with someone who has been diagnosed with COVID-19?:
Does your child(ren), or anyone in your household have any of the following symptoms: fever, chills, shortness of breath/difficulty breathing, new cough, excessive runny nose, vomiting, diarrhea, new loss of taste/smell?:
Is anyone in your household currently awaiting results from a pending COVID-19 test?
Since you were last at school, has your child been diagnosed with COVID-19?
Does your child have a temperature of 100.4 or above?
Since your child was last at school, has he/she traveled out of the country or to a COVID-19 hot spot within the US?
Has your child(ren) had any medication this morning that could mask symptoms he/she is experiencing?
Explanation of a "yes" answer above:
Should be Empty: