Ursuline Academy Daily Wellness Check
Please complete this form for EACH child who attends Ursuline before coming to school each day. Within one hour of leaving for school, parents/guardians must check the health of their child with the questions below.
Sign in to Google to save your progress. Learn more
STUDENT email *
Student LAST name *
Student FIRST name *
Student's Year of Graduation *
Please answer the following screening questions.  Does your child have: *
YES
No
Fever of 100° F or higher
Chills or shaking chills
Cough (not due to a known cause)
Difficulty breathing or shortness of breath
A recent loss of taste or smell
Sore throat
Headache, in combination with other symptoms
Muscle or body aches
Nausea, diarrhea, or vomiting
Fatigue, in combination with other symptoms
Nasal congestion or a runny nose, not due to a known cause such as allergies
Recent exposure to a person with a confirmed COVID-19 diagnosis
A recent positive test for COVID-19 (since last at school)
Recent travel to/from an area requiring quarantine by MA State guidelines
IF YOU ANSWERED "NO" TO ALL OF THE ABOVE QUESTIONS, WE LOOK FORWARD TO SEEING YOUR DAUGHTER AT SCHOOL TODAY.
IF YOU ANSWERED "YES" TO ANY OF THE ABOVE QUESTIONS, PLEASE KEEP YOUR DAUGHTER AT HOME; DO NOT COME TO CAMPUS. INSTEAD, PLEASE FOLLOW THESE STEPS:
1. Call Ursuline (781-801-1589) and inform the school that your daughter is staying home due to symptoms (please be specific).
2. Contact your daughter's physician.
3. Current Massachusetts DPH guidance is that all symptomatic individuals in Massachusetts, even those with mild symptoms, should be tested. **Please note that Ursuline requires/accepts PCR tests only.** An individual who does not wish to be tested may return to school 10 days from the start of symptoms, as long as their symptoms have improved and they have been without fever for at least 24 hours prior to their return to school without the use of fever reducing medication.
4. Upon return to campus, the student should visit the School Nurse.
PARENT / GUARDIAN email *
By typing my name below, I certify that, as the parent/guardian of the above student, I have followed the above protocol to assess my child's wellness. *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Ursuline Academy. Report Abuse
Google Forms