COVID Symptom Checklist

For in-person tutoring sessions, we must all use an abundance of caution to keep both our families and tutors safe. With that in mind, we will be enforcing strict safety and sanitation procedures for all in-person sessions for the foreseeable future.

1. Do you have a fever, or have you felt feverish recently?
 
 Yes No
 
 

2. Do you have a cough?
 
 Yes No
 
 

3. Are you having shortness of breath or any difficulty breathing?
 
 Yes No
 
 

4. Do you have chills or repeated shaking with chills?
 
 Yes No
 
 

5. Do you have any muscle pain or body aches?
 
 Yes No
 
 

6. Do you have any headache or sore throat?
 
 Yes No
 
 

7. Have you been experiencing nausea and/or vomiting?
 
 Yes No
 

8. Do you have any loss of taste or smell?

Yes No
 
 

9. Have you been experiencing fatigue recently?

Yes No
 
 

10. Have you experienced any recent GI upset or diarrhea?

Yes No
 
 

11. Have you been advised to self-quarantine due to exposure to someone with COVID-19?

Yes No
 
 

12. Have you traveled in the past 14 days to any regions affected by COVID-19?

Yes No
 
 

13. Have you been tested for COVID-19? If yes, what was the result?

Yes No
 
 

14. Have you been diagnosed with COVID-19? If yes, when?

Yes No
 
 

Thank you for your honesty and cooperation! Together, we can stop the spread of COVID-19!