Same-Day Health Screening

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same-day health screening for students

Updated 1/3/2022 in accordance with the most recent CDC guidelines.

Please complete this screening (prior to arriving at our studio) each day your student will be attending an in-person class or event with us.

(must be completed and submitted on the SAME DATE as the class/event your student is attending)

* Indicates required field

Student's Name *

First

Last

My Name *

First

Last

My Email *

LEVEL 1 SYMPTOMS
- Muscle or body aches
- Headache
- Congestion or runny nose
- Cough

1. Has this student had any of these LEVEL 1 symptoms within the last 48 hours? *

Yes No

If yes, please list ALL the LEVEL 1 symptoms the student has that are CONFIRMED TO BE CAUSED BY A CONDITION OTHER THAN COVID-19 (e.g. cough due to seasonal allergies) *

Your judgment impacts the health of others. Please consider this carefully.

A MUSEO administrator will review this information and contact you if we have reasonable concerns of potential risk to others if this student were to attend today.

LEVEL 2 SYMPTOMS
- Fever (body temp of 100.0 or higher)
- Chills
- Shortness of breath or difficulty breathing
- Fatigue
- Recent loss of taste or smell
- Sore throat
- Nausea or vomiting
- Diarrhea
- Stomach ache or pain in the abdomen

2. Has this student had any of these LEVEL 2 symptoms within the last 48 hours? *

Yes No

Per the CDC and Washington State Department of Health, the presence of any of these LEVEL 1 and LEVEL 2 symptoms WHICH IS NOT CAUSED BY ANOTHER KNOWN CONDITION will exclude the student from participating in an in-person class today.

3. Has this student been in close contact with anyone who has COVID-19 in the past 5 days? Close contact is being within 6 feet for 15 minutes or more over a 24-hour period with a person; or having direct contact with fluids from a person with COVID-19 with or without wearing a mask (i.e., being coughed or sneezed on). *

Yes No Possibly

4. Has this student had a positive COVID-19 test for active virus in the past 5 days or is this student awaiting results of a COVID-19 test? *

Yes No

5. Within the past 5 days, has a public health or medical professional directed this student to be monitored, isolated, or quarantined because of concerns about COVID-19 infection? *

Yes No

Additional Comments *

By typing my full name into the box below, I certify that my responses are true and accurate. I acknowledge that I play a vital role in the health and well-being of the entire MUSEO Art Academy community. *

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