St Matthew Student Check

St Matthew School

St Matthew Check

COVID-19 Health Screening Form

Within the last 10 days have you been diagnosed with COVID-19 or had a test confirming you have the virus?
Within the past 14 days did you live in the same household as, or did you have close contact with, someone who tested positive for COVID-19 and/or someone who has been in isolation for COVID-19? (Close contact is less than 6 feet for 15 minutes or more regardless of whether masks were worn or not)
Have you had any new or unexplained symptoms since the last symptom check?
At least 1 of the following:
  • Fever (temperature ≥ 100.4° F /38° C or subjective fever)
  • Vomiting
  • Diarrhea
  • Conjunctivitis or “pink eye”
  • Rash
  • New loss of taste or smell (i.e., new olfactory or taste disorder)
  • Painful purple or red lesions on the feet or swelling of the toes (“COVID Toes”)
OR At least 2 of the following:
  • Chills
  • Repeated shaking with chills (rigors)
  • Cough (new or change in baseline)
  • Shortness of breath or difficulty breathing (new or change in baseline)
  • Chest pain with deep breathing
  • Sore throat
  • Hoarseness
  • Muscle pain (myalgias)
  • Malaise or severe fatigue
  • Abdominal pain
  • Loss of appetite
  • Nausea
  • Headache
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