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COVID-19 Health Screening Form

Student Health Screening Entry Form

Please assess your child daily for the following symptoms and answer the contact questions.

  • Fever of 100.4 or higher
  • Uncontrolled cough
  • Shortness of breath or difficulty breathing
  • Sore throat
  • Loss of sense of smell or taste
  • Muscle aches
  • Vomiting or diarrhea


  • Is your child currently awaiting COVID-19 test results?
  • Does your child live in the same household with someone positive for COVID-19? If yes, please keep your child home and notify the school nurse when test results are received.  Further instructions will be discussed at that time.
  • Has your child had close contact with someone who in the past 14 days tested positive for COVID-19? If yes, your child must quarantine for 10 days from the last date of contact with the positive individual.  The quarantine period may be shortened to as few as 7 days if a negative PCR test result is obtained on day 6 or later from exposure to the positive case.  The Department of Health will assist in clearing your child to return to school once they have received the negative test result.