Parent Verification of Health Screening Questionnaire

Parent Verification of Health Screening Questionnaire
Posted on 10/01/2020
Parent Verification of Health Screening Questionnaire: For all students reporting to school for in-person learning

Before students return to school parents need to complete and turn in the   Parent Verification of Health Screening Questionnaire.

If we do not have this form on file, a nurse or staff member will call you to ask the questions before your child is allowed to enter the school.

All students who are reporting to school for in-person learning (cohort A & cohort B) will need to complete the below Public Health Questionnaire daily: 

Health Screening Questionnaire

  1. Do you/your child currently have (or have had in the last 10 days) one or more of these new or worsening symptoms?

    • A temperature greater than or equal to 100.0° F (37.8° C)
    • Feel feverish or have chills
    • Cough
    • Loss of taste or smell
    • Fatigue/feeling of tiredness
    • Sore throat
    • Shortness of breath or trouble breathing
    • Nausea, vomiting, diarrhea
    • Muscle pain or body aches
    • Headaches
    • Nasal congestion/runny nose

     

  2. In the past 10 days, have you/your child tested positive for COVID-19 OR are you waiting for a COVID-19 test result?
  3. Have you/your child been designated a contact of a person who tested positive for COVID-19 by a local health department?
  4. In the last 14 days, have you/your child traveled internationally to a CDC level 2 or 3 COVID-19 related travel health notice country or traveled to a state or territory on the NYS Travel Advisory List?

If you’ve answered NO to all of the above questions, you have PASSED the health screening.

If you’ve answered YES to any of the above questions, you have FAILED the health screening.