Student Daily Health Questionnaire
Please refer to the following questions daily prior to departing for school.
This form is not to be returned to the school.
Question #1: Does your child have a body temperature of 100.0 degrees or above today?
Question #2: Is your child experiencing any NEW symptoms of:
cough
shortness of breath
sore throat
loss of taste or smell
chills
muscle aches
headache
nausea/vomiting
diarrhea
congestion/runny nose
fatigue
Question #3: Has your child been in close proximity (6 feet for 10 minutes or more)
of a person with confirmed COVID-19 in the last 14 days?
Question #4: Has your child been tested for COVID-19 due to exhibiting
COVID-19 symptoms OR had potential exposure to someone
who may have COVID-19 and are awaiting test results?
Question #5: In the past 14 days, has your child traveled outside of the
United States or to any travel restricted state?
If you answered YES to any of the above questions, do NOT send your child or children to school. Please contact the school nurse or your doctor for further instructions. Thank you!
