COVID Screening

Does your child have a fever (temperature over 100.4F/38C degrees) without having taken any fever-reducing medications?

Does your child have loss of smell or taste?

Does your child have a cough?

Does your child have a sore throat?

Does your child have congestion or a runny nose?

Does your child have shortness of breath?

Does your child have chills?

Does your child have a headache?

Has your child experienced any new gastrointestinal symptoms such as nausea, vomiting, diarrhea, or loss of appetite in the last few days?

Has your child, or anyone your family has been in close contact with, been diagnosed with COVID-19 or placed in quarantine for possible exposure to COVID-19 within the last two weeks?

Has your child or anyone your family has been in close contact with been asked to self-isolate or quarantine by a medical professional or a local public health official in the last two weeks?

YES

NO

Positive

Negative

H.O.K.E. ACADEMY
Helping Our Kids Exceed

Item Title

How We Go Back to School

COVID-19 Screening Questionnaire (Virtual Week (1/18-1/21) Return to School)

H.O.K.E. ACADEMY Helping Our Kids Exceed

How We Go Back to School

COVID-19 Screening Questionnaire (Virtual Week (1/18-1/21) Return to School)

H.O.K.E. ACADEMY
Helping Our Kids Exceed