Holy Angels School

Wellness Check

COVID-19 Health Screening Form

Do you or your child live with anyone or have you or your child had close contact with anyone with a prolonged cough, fever, flu-like symptoms or been diagnosed with COVID-19 within the last 14 days?

Yes No

Do you or your child live with anyone, have had close contact or do you or your child have a fever, cough and/or shortness or breath? For children and adults, fever is 100.4 degrees or above using a forehead thermometer.

Yes No

Do you or your child live with anyone, have had close contact or do you or your child have any other signs of communicable illness such as a cold, flu, rash or inflammation?

Yes No

Do you or your child live with anyone, have had close contact or have you or your child experienced diarrhea or vomiting (within the past 24 hours)?

Yes No

Questions based on guidelines by the Archdiocese of San Francisco and the San Mateo County Health Department. If you or your child show any of the above symptoms, please stay home and refrain from coming to school. For more COVID-19 information refer to covid19.ca.gov