Student Health Prescreening Attestation


All students must conduct this health self-screen daily before entering the school

Have you had any symptoms of COVID-19 in the past 14 days, including a temperature above 100 degrees F?

According to the CDC guidance on “Symptoms of Coronavirus,” people with COVID-19 have had a wide range of symptoms reported, ranging from mild symptoms to severe illness. Symptoms of COVID-19 include, but are not limited to: cough, shortness of breath or difficulty breathing, fever, chills, muscle pain, sore throat, or new loss of taste or smell.

Have you tested positive for COVID-19 in the past 14 days?

Have you been in close contact with a person who has or is suspected of having COVID-19 in the past 14 days?

Have you traveled internationally or from a state with widespread community transmission of COVID-19 per NYS Travel Advisory in the past 14 days?

Further information on the list of states subject to the travel advisory be found at https://coronavirus.health.ny.gov/covid-19-travel-advisory

Student First Name

Student Last Name

Student Birthdate (mm/dd/yy)