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Covid Daily Survey

Please fill this survey daily before your child enters the center

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* 1. What is your name?

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* 2. Are you or your children taking fever - reducing medicines, such as those that contain aspirin , ibuprofen or acetaminophen, in or to reduce your fever?

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* 3. Do you or children have a temperature  higher than 99°F?

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* 4. Have you or your children had close contact or cared for someone with COVID-19 in the past 14 days?

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* 5. Have you or your children had returned from travel from outside the United States or cruise ship or river boat within the past 14 days?

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* 6. Do you or your children have any of these symptoms?
 fever or chills
cough
shortness of breath or difficulty breathing
fatigue
muscle or body aches
headache
new loss of taste or smell
sore throat
congestion or runny nose
nausea or vomiting
diarrhea

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* 7. What is today's date?

Date
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