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

Student First Name

Student Last Name

Student Birthdate (mm/dd/yy)