Daily Health Questionnaire

To prevent the spread of COVID-19 and reduce the potential risk of exposure to our students and staff, we are requiring parents to complete this Daily Health Questionnaire for their student(s) each day prior to arrival. Once the form is complete you will receive an email with your single use clearance pass needed for check in. 
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Section 1: Student Health & Wellness Checklist

Are you experiencing any of the following symptoms or combination of symptoms?
If so, please select "yes" and explain more in the comment section below.
 
- Cough
- Shortness of breath
- Fever (100.4┬║ F) or higher
- Chills
- Sore throat
- Repeated shaking with chills
- Headache
- Muscle pain
- New loss of taste/smell *
 
Are you currently waiting for COVID-19 test results?
If so, please select "yes" and explain more in the comment section below. *
 
Have you tested positive for COVID-19 in the last 30 days?
If so, please select "yes" and explain more in the comment section below. *
 

Section 2: Social Distancing & Exposure

Not including the government mandated stay at home order, has anyone from your household had to self quarantine (i.e. remaining in your home and outdoor activities without coming closer than 6-ft from others)?
If so, what dates and why? *
 
Have you been exposed to anyone currently waiting for COVID-19 test results due to suspected illness?
If so, please select "yes" and explain more in the comment section below. *
 
Have you been exposed to anyone who has tested positive for COVID-19 in the last 30 days?
If so, please select "yes" and explain more in the comment section below. *
 
Have you been exposed to anyone with any of the following symptoms or combinations of symptoms?
If so, please select "yes" and explain more in the comment section below.

- Cough
- Shortness of breath
- Fever (100.4F) or higher
- Chills
- Sore throat
- Repeated shaking with chills
- Headache
- Muscle pain
- New loss of taste/smell *
 
REVISED: Have you traveled outside the state or country in the past 10 days?
If so, please select "yes" and explain more in the comment section below. *
 
I understand that if I have answered YES to any of the above questions that my student(s) may not be admitted on to Foothill's campus for TODAY. Also, if my student(s) exhibits any of the above symptoms while at school, I understand that they will be quarantined and will need to be picked up immediately. *
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