Holy Angels School

Wellness Check

COVID-19 Health Screening Form

Within the last 10 days have you or your child been diagnosed with COVID-19 or had the test confirming you or your child have the virus?

Yes No

Within the past 14 days did you or your child live in the same household as, or did you or your child 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 or 15 minutes or more regardless of whether masks were worn or not.

Yes No

Have you or your child had any new or unexplained symptoms since the last symptom check? At least one of the following: fever greater than or equal to 100.4 degrees Fahrenheit, vomiting, diarrhea, conjuntivitiis 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 or "COVID Toes"

Yes No

Have you or your child had any new or unexplained symptoms since the last symptom check? At least 2 of the following: chills, repeated shaking with chills (rigors), cough (new or change in baseline), chest pain with deep breathing, chest pain with deep breathing, sore throat, hoarseness, muscle pain (myalgias), malaise or severe fatigue, abdominal pain, loss of appetite, nausea, headache

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