Saint Paul Diocesan Junior / Senior High School Daily Health Questionnaire

Saint Paul Diocesan Junior / Senior High School Daily Health Questionnaire
Device Time

Year Month Day
Date Hour Minutes AM/PM Option
Name *

First (Given) Name Last Name (Surname)
Risk
Email *
(This sends the results to your email, enabling documentation.)
Are you experiencing any of the following symptoms?
- Fever or chills
- Cough
- Shortness of breath or difficulty breathing
- Fatigue
- Muscle or body aches
- Headache
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea or vomiting
- Diarrhea
Are you experiencing any of the following symptoms? *

Yes No
Are you living with or caring for an individual who is a suspected or confirmed case of COVID - 19? *

Yes No
Have you been in contact with anyone known or suspected to have COVID - 19 in the last 14 days? *

Yes No
Have you tested positive for COVID-19 in the last 14 days? *

Yes No
I certify all the information provided is shared to the best of my ability.
Should be Empty: