Temperature Form

Temperature Form

Temperature Form
To be completed when student/staff member has symptoms of COVID 19.

Name
Grade
Building
Staff Member or Parent's Email Address
Date Form Submitted
Current Temperature
Time Temperature Taken
Have you had a cough, shortness of breath/difficulty breathing, a fever, chills, muscle pain, sore throat, or loss of taste and/or smell within the last 14 days?
Have you been in contact with anyone that has had a cough, shortness of breath/difficulty breathing, a fever, chills, muscle pain, sore throat, or loss of taste and/or smell within the last 14 days?
Your Name:
Your Email:
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