Health Screening Form (Staff/Visitor)

  • Hitherfield School COVID Screening Questions



  • 1. Are you currently experiencing any of these symptoms?

    The symptoms listed here are the symptoms most commonly associated with COVID-19. Our guidelines for children and adults continue to evolve as we learn more about COVID-19, how it spreads, and how it affects people in different ways.

    Choose any/all that are new, worsening, and not related to other known causes or conditions you already have.

  • Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher and/or chills.

  • Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, or other known causes or conditions you already have)

  • Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions you already have)

  • Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have

  • Unusual, fatigue, lack of energy (not related to depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have)

    If you received a COVID-19 vaccination in the last 48 hours and are experiencing mild fatigue that only began after vaccination, select “No.”

  • Unexplained, unusual, or long-lasting (not related to sudden injury, fibromyalgia, or other known causes or conditions)

    If you received a COVID-19 vaccination in the last 48 hours and are experiencing mild muscle aches/joint pain that only began after vaccination, select “No.”

  • If the individual experiencing symptoms received a COVID-19 vaccination in the last 48 hours and is experiencing mild headache, fatigue, muscle aches, and/or joint pain that only began after vaccination, select “No.”

  • If public health has advised you that you do not need to self-isolate, select “No.”

  • If you already went for a test and got a negative result, select “No.”

  • This can be because of an outbreak or contact tracing.

  • If you have since tested negative on a lab-based PCR test, select “No.”

  • Date Format: MM slash DD slash YYYY