Daily Health Screening (Student) Daily Health Screening (Student)Please note you must do one submission for each Imagination School student in your family.Student’s Name*Today’s Date* Date Format: MM slash DD slash YYYY Does your student have, [or have had in the past three days (72 hours)], any of the following symptoms:1. Cough?*YesNo2. Shortness of breath or difficulty breathing?*YesNo3. A fever of 100.4 or higher or a sense of having a fever?*YesNo4. A sore throat?*YesNo5. Chills?*YesNo6. New loss of taste or smell?*YesNo7. Muscle or body aches?*YesNo8. Nausea/vomiting/diarrhea?*YesNo9. Congestion/running nose – not related to seasonal allergies?*YesNo10. Unusual fatigue?*YesNo11. Does anyone in your household have any of the above symptoms that are not attributable to another condition?*YesNo12. Has your student been in close contact with anyone with suspected or confirmed COVID-19?*YesNo13. Has your student had any medication to reduce a fever before coming to school?*YesNoParent Name*Parent Email* Please check the box beside the statement:* I certify that the information submitted in this form is true. Your Child's temperature will be taken at the school.Do you want to submit the health screening questionnaire for another child?*YesNoWhen you click the submit button, it will redirect to the same form in order to submit the questionnaire for another child.
