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NHS In-Building Support Student Health Screener
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* Indicates required question
Last Name
*
Your answer
First Name
*
Your answer
TODAY'S DATE
*
MM
/
DD
/
YYYY
Grade
*
9
10
11
12
Assigned Location
*
Lower Commons- 9th Grade
Media Center- 10th Grade
Media Center- 11th & 12th Grade
SAT Testing - October 14th - Class of 2021 only
PSAT/NMSQT Testing - October 29th - Class of 2022 only
Do you have a temperature of 100.4 or greater?
*
yes
No
Do you have a sore throat?
*
Yes
No
Do you have a NEW uncontrollable cough that causes you to have difficulty breathing? (For students with chronic allergic/asthmatic cough, a change in their cough from the usual baseline)
*
Yes
No
Do you have diarrhea, abdominal pain, or have you been vomiting?
*
Yes
No
Do you have a new onset of a severe headache, especially with a fever?
*
Yes
No
In the past 14 days, have you had close contact (within 6 feet of an infected person for at least 15 minutes) with a person with confirmed COVID-19?
*
Yes
No
In the past 14 days, have you had close contact (within 6 feet of an infected person for at least 15 minutes) with a person under quarantine for possible exposure to COVID-19?
*
Yes
No
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