Covid -19 – Daily Health Screening For Students (Heritage House Location) Covid -19 - Daily Health Screening For Students (Heritage House Location) Please note you must do one submission for each Roots and Wings Montessori student in your family.Student Name*Temperature*Does any of the following apply to the individual?A temperature in excess of 37.8 degrees Celsius*YESNOAny medication given for the purpose of fever reduction in the 8 hours prior to school arrival time*YESNOChills*YESNOA new or worsening cough*YESNOSore throat*YESNOShortness of breath*YESNODifficulty swallowing*YESNOLoss of taste or smell*YESNORunny nose or nasal congestion not attributed to allergies or another known cause*YESNONausea, vomiting and / or diarrhea*YESNOExtreme tiredness that is unusual*YESNOHeadache that is unusual or long lasting*YESNOConjunctivitis ( eye discharge / Pink Eye )*YESNODoes anyone in the household have any of the above symptoms?*YESNOHas the individual:Had close contact with a positive COVID case or to someone experiencing symptoms?*YESNOTravelled outside of Canada in the last 14 days or exposure to someone with recent travel?*YESNOBeen informed by Public Health or another authority to self-isolate or quarantine in the past 14 days?*YESNOSignature*Name*Email* Date This iframe contains the logic required to handle Ajax powered Gravity Forms.