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Confirmation of Wellness

As outlined in the Health and Safety Plan COVID-19 Addendum to the Parent Handbook, Please answer the following questions on weekdays: before the start of school, after each absence, and after each break.

These questions should serve as a daily COVID-19 exposure checklist. Please ask yourself these questions and perform a temperature check for every member of your family each morning.

Questionnaire

*1. I/my child(ren) agree to follow FISW's physical distance, health, and safety protocols.

*2. I understand that if someone in my household is sick or has one or more of the symptoms listed in question 3, that my child and/or I

must stay home or leave the School.
must follow the School’s procedure for calling in sick or requesting to work from home.
should contact my health care provider for medical guidance.
can return to school in accordance with the School’s Plan for Suspected COVID-19.

3. Someone in my household has

Check all that apply

A new fever (100.4 F or higher) or a sense of having a fever
A new cough that you cannot attribute to another health condition
New shortness of breath that you cannot attribute to another health condition
A new sore throat that you cannot attribute to another health condition
New muscle pain that you cannot attribute to another health condition or that may have been caused by a specific activity, such as physical exercise
New gastrointestinal symptoms, such as nausea, vomiting or diarrhea that you cannot attribute to another health condition
New respiratory symptoms, such as a runny nose, that you cannot attribute to another health condition
New chills that you cannot attribute to another health condition
New loss of taste or smell that you cannot attribute to another health condition
A new headache that you cannot attribute to another health condition or emotional reason
Unusual tiredness or fatigue

4. Someone in my household has taken medication to artificially lower a fever in the last 72 hours.

5. Someone in my household has had a COVID-19 symptoms such as fever, cough, sore throat, and fatigue in the last 72 hours.

6. Someone in my household has had a positive COVID-19 test for active virus in the past 10 days.

7. Someone in my household has been in contact with another person who has displayed signs or symptoms of COVID-19 in the past 14 days.

8. Someone in my household has been in contact with another person who has been diagnosed as positive for COVID-19 in the past 14 days.

9. In the past 14 days, someone in my household has been instructed to self-monitor, self-isolate, or self-quarantine due to any reason, including travel outside of the region.

Someone in your household has already filled in the form for the current day.

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Answering questions 1 and 2 is required.

Submit