Daily Student Health Questionnaire

To make sure we are protecting the health and safety of our students and our faculty during this time, we ask that you would please fill out our Daily Student Health Screening Questionnaire and submit it to us prior to the start of each school day.

We appreciate your understanding as we work to provide a safe and healthy environment for your child to flourish in. If you would like more information about the steps we are putting in place, please view our COVID-19 SAFETY PLAN.

If you'd like to download and print our Daily Student Health Screening Questionnaire, CLICK HERE.

Daily Student Health Screening Questionnaire

Your Name*
First Last
Your Student's Name*
First Last
Today's Date*
Month
Day
Year
Your Email Address*
1. Has your student had any known contact with a person confirmed or suspected to have COVID- 19 in the past 14 days?*
- Yes
- No
2. Has your student had a COVID-19 test in the past 14 days?*
- Yes
- No
3. In the past 14 days, has your student had any COVID-19 symptoms that are not attributed to another condition? Examples include but are not limited to cough, shortness of breath or difficulty breathing, fever or chills, muscle or body aches, headache, new loss of taste or smell, and/or sore throat.*
- Yes
- No
If you answered YES to one or more of the above questions, your student will not be permitted to attend school. You should consult with a health care provider for assessment as a doctor’s note will be required before your student may return to Abilities.
4. Has your student traveled outside of New York to a location listed on the Travel Advisory Restricted States list in the past 14 days?*
- Yes
- No
If you answered YES to question 4, your student will not be permitted to attend school and must quarantine. Documentation will be required indicating the quarantine period. You may contact a health care provider or local health department for your county. If you answered NO to the screening questions 1-3, and your student did not travel to a state listed on the NY Travel Advisory Restricted States list, your student may report to school at Abilities. Students must also meet the temperature screening guidelines upon arrival to attend school. If a reading of 100.0 degrees Fahrenheit or higher is recorded, your student will not be authorized to attend class.
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Daily Student Health Questionnaire

view our covid-19 safety plan

Daily Student Health Screening Questionnaire