Daily Health Screening Form-Purcellville Montessori

Daily Health Screening Form-Purcellville Montessori

  • Is anyone in your household sick or experiencing any of the above symptoms?

  • Have you or anyone in your household travelled internationally, domestically, or to a known hotspot in the last 14 days?

  • Have you or your children attending the program had close unprotected* contact (face- to-face contact within 2 meters/6 feet) with someone who is ill with cough and/or fever?

  • Have you or anyone in your household been in close unprotected contact in the last 14 days with someone who is being investigated or confirmed to be a case of COVID-19?

  • Date Format: MM slash DD slash YYYY