OCRS Monitor to Stay Daily Attestation Form

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Your child has been identified as a close contact to a positive Covid case. Your child can stay in school during their quarantine period if you screen them DAILY for symptoms and attest DAILY that they are symptom free. This form must be submitted EACH MORNING prior to the student's arrival in order to participate in Monitor-to-Stay.

Student Last Name *

Student First Name *

Grade *

Is your child attending school today? *

Yes

Does your child have any symptoms today? *

NO SYMPTOMS

Cough

Shortness of breath/difficulty breathing

Loss of taste (new)

Loss of smell (new)

Fever (above 100.4)

Chills

Muscle/body aches

Headache

Sore throat

nausea/vomiting

Congestion (new)

Runny nose (new)

Diarrhea

Other:

I understand that if my child develops symptoms during the day they must immediately report to the nurse. Please be prepared to dismiss your child should this occur. Those identified as close contacts must also correctly wear a well-fitting mask at all times while at school. *

Yes

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