Health Screening Form

Health Screening Form

The Owings Mills Chabad Hebrew School
Family Name*
Child 1*
Child 2
Has anyone in your family been exposed to anyone suspected or confirmed to have COVID-19 in the past 14 days?*

No Yes
Has your child had any medication to reduce a fever before coming to school?*

No Yes
Has your child, or anyone in your household, experienced any of the following in the last week: fever 100.4 or higher, sore throat, nasal congestion, runny nose, cough or shortness of breath, headaches, body aches, nausea, vomiting, diarrhea, chills or shaking, Covid toe, or loss of taste or smell?*

No Yes
Should be Empty:

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