COVID-19 Daily Health Check
for School Staff
Name
Date
Email (optional)
Symptoms (check all that apply):
Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
In the past 14 days:
Have you had close contact with someone diagnosed with COVID-19?
Have you traveled internationally?
I certify the above information is accurate.