Daily Covid-19 Screening Form | Divine Savior Holy Angels High School

Student's / Employee's Name: *

First Name and Last Name

Student's / Employee's ID Number: *

How are you feeling today?: *

Do you feel feverish or have a fever (100.4 or higher)?: *

Yes

No

Are you experiencing any of the following (Check ALL that apply): *

Have you been in contact with someone who has tested positive for COVID-19, has COVID-19 or is being evaluated for COVID-19?: *

Have you been tested for COVID-19 in the past 14 days?: *

Yes, tested positive

Yes, tested negative

No

Scheduled