Symptoms Checklist

Daily Check

  • If you answer Yes to any of these questions, stay at home and contact your school.

  • For staff or students (grades 6-12): Do you have any of the following symptoms in the past 24 hours that are not caused by another condition?

  • For families (grades 5 or below): Does your child have any of the following symptoms in the past 24 hours not caused by another condition?

  • For anyone returning from a break or for new staff/student: Have they had any of the following symptoms in the past 3 days?


  • Fever 100.4⁰F / 38°C or higher

  • Cough

  • Shortness of Breath or Difficulty Breathing

  • Chills

  • Fatigue

  • Muscle Pain or Body Aches

  • Headache

  • New Loss of Taste or Smell

  • Sore Throat

  • Congestion or Runny nose

  • Nausea or Vomiting

  • Diarrhea

  • Other signs of new illness that are unrelated to a preexisting condition (such as seasonal allergies)

  • Have you been in close contact with anyone with confirmed COVID-19? Close contact means being within 6 feet (2 meters) of an infected person for 15 minutes or more.

  • Have you had a positive COVID-19 test for active virus in the past 10 days?

  • Within the past 14 days, has a public health or medical professional told you to self-monitor, self-isolate, or self-quarantine because of concerns about COVID-19?

  • It is important to seek medical attention immediately if any of your symptoms become severe.

  • Name and Signature

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