Covid Screening - Stanford Eisenberg Knoxville Jewish Day School

Your E-mail*

Your Child's Name*

Has anyone in the family been in close contact with a confirmed case of COVID-19 within the past 14 days?*

Yes No

Is your child experiencing a cough, shortness of breath, sore throat or stomach syptoms?*

Yes No

Has your child had a fever in the last 48 hours?*

Yes No

Has your child had new loss of taste or smell?*

Yes No

Has your child had vomiting or diarrhea in the last 24 hours*

Yes No

What was your child's temperature this morning?*

Has anyone in the family travelled anywhere new since you last filled out this form?*

Yes No

If travel has occured please include the desitnation and nature of the travel.