COVID-19 DAILY SELF CHECKLIST
PLEASE COMPLETE EACH DAY PRIOR TO ARRIVING AT SCHOOL EACH DAY. IF YOU ANSWER YES TO ANY OF THE QUESTIONS, PLEASE CONTACT YOUR BUILDING PRINCIPAL BEFORE COMING TO SCHOOL.
NAME *
Date *
Date
SCHOOL *
Do you have a fever? *
Have you lost your sense of taste or smell? *
Do you have muscle aches? *
Do you have a sore throat? *
Do you have a cough? *
Do you have shortness of breath? *
Do you have the chills? *
Do you have a headache? *
Do you have GI symptoms such as nausea, diarrhea, loss of appetite? *
Have you or anyone you have been in close contact with been diagnosed with COVID-19, or been placed in quarantine for possible contact with someone who has COVID-19? *
Have you been asked to self-isolate or quarantine by a medical professional or local public health official? *
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