Daily Checklist

Symptom Checklist

Parents are asked to review this daily health checklist by answering these questions before sending their child to school.

(Parents do not need to send the questionnaire to school)

Has your child had close contact with a confirmed case of COVID-19 in the past 14 days?

Yes____ No____

Does your child have a new or worsening shortness of breath?

Yes____ No____

Does your child have a new or worsening cough?

Yes____ No____

Has your child had a fever of 100.4 or greater (without fever reducing medication) in the last 24 hours?

Yes____ No____

Does your child have chills?

Yes____ No____

Does your child have a sore throat?

Yes____ No____

Does your child have a new loss of taste or smell?

Yes____ No____

Has/does your child have diarrhea or have they vomited in the last 24 hours?

Yes____No______

Has your child experienced a headache, muscle aches, or abdominal pain?

Yes ___No______

Do you have a pending COVID-19 test?

Yes ___No______