Printed Health Verification Form

  • Sign & Date the Daily Student Wellness Form

    Pen and signature Hybrid students in grades PK-6 at select elementary schools must bring a printed daily wellness screening form signed by a parent/guardian to school each day.

    All other elementary, middle, and high schools have chosen the electronic Skyward wellness screening as their primary screening method.

    Students who have chosen to remain in remote learning do not need to complete a daily wellness screening form.

    Schools Provide Printed Health Verification Forms

    The school will provide a printed health verification form for each student.

    • Before April 12: Look for a temporary form in the mail.
    • On April 12: Students will receive the form at school.
    • After April 12: Contact your school to request a replacement.

    The health verification form is available in English, Spanish, Punjabi, Vietnamese, Ukrainian, Somali, Arabic, and Dari

    Steps to Complete the Form Before School

    A parent/guardian must complete and sign the form for their elementary student(s).

    1. Check your student for the symptoms listed on the form.
    2. Answer the questions listed on the form.

    If you answered NO to all the questions:

    1. Sign and date the form in the next available slot.
    2. Place the form in your student’s backpack and send them to school.

    If you answered YES to any of the questions:

    1. Keep your student home.
    2. Report the absence to your student’s school.
    3. Contact your health care provider.

    The symptoms listed on the COVID-19 student wellness form overlap with common chronic conditions, including asthma, diabetes, chronic fatigue syndrome, seasonal allergies, life-threatening allergies, irritable bowel syndrome, congenital heart conditions, and more. These symptoms also overlap with common infectious diseases including influenza, the common cold, norovirus (stomach flu), roseola, and more.

    A student who presents with symptoms related to a condition that is not COVID-19 may return to school with a negative COVID-19 test or a letter from their healthcare provider indicating that their symptoms are not related to COVID-19.

    Student Wellness Will be Confirmed at School

    School staff will review the student's printed health verification form for a parent/guardian signature and check the student for fever and other COVID-19 symptoms if needed upon arrival.

    School staff members are trained on signs and symptoms of COVID-19 to look for during the school day and at entry for students who may be feeling unwell. They are also trained in how to protect student privacy during re-screening.

    If you did not complete the wellness screening form and the student has already arrived at school, staff will call home to request a verbal health check or prompt a digital health check.

    If the student has a temperature of 100.4 or higher, they will be asked to step aside and be re-screened with another thermometer. If a student has a verified temperature of 100.4 or higher, they will be brought to the wellness room until they can be picked up to go home. School staff will inform the school nurse of a YES answer on or of fever for follow-up.

What it Looks Like

  • The side of the health verification form that parents/guardians sign and date every day

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Last Modified on April 7, 2021