Student Daily Wellness Assessment Form

Do you have any of the following symptoms in the last 14 days?

If the student answered yes to any of the symptoms in the table above, the student must stay home until the symptom is gone for a day.
It is also recommended to have a COVID test in order to make sure what is the root cause of the symptom.
Were you in close contact with anyone who is positive for COVID-19?
YesNo
Did you traveled anywhere from the last 7 days?
YesNo
Do you have a family or household member who has symptoms of COVID-19?
YesNo
Do you have a family or household member who is positive for COVID-19?
YesNo
By signing below, I confirm that the information I entered in this document regarding my health condition is accurate and true.
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