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Pre-School: Student Daily Health Check

Dear Parent/Guardian,

Please complete the following Daily Covid-19 questionaire below for your student. This questionnaire must be completed daily before your student enters the building.

Thank you

Student Name*

Answer Required

Does your student have any of the below symptoms? (Please focus on new or unexpected symptoms.)*

Answer Required

Yes

Fever of 100.4 or higher over the last 24 hours without the use of fever-reducing medication
Feeling feverish (chills, sweating) or having chills
New cough or sore throat
Shortness of breath or difficulty breathing
Muscle aches or body aches
Vomiting or diarrhea over the last 24 hours
New loss of taste or smell
Fatigue
New or unusual headaches

Has your student had close contact (within 6 feet for at least 15 minutes) with a person known to be infected with COVID-19 within the last 14 days?*

Answer Required

Yes

Name of Parent/Guardian completing this form*

Answer Required