Covid Questionnaire for Students, Staff and Visitors


This is the Covid screening tool that will be used on anyone entering the Faithful Academy Building.  Each morning the children will need to turn in this form, that must be signed by parents.  There will be temperature checks done on arrival and children will immediately wash hands and sanitize.  Call Faithful with additional questions.  Thank you for working with us to keep our campus safe! 


Covid Questionnaire for Students, Staff and Visitors


Date: _______________________


Childs name: __________________________________________

Temperature check:               YES              NO


Circle any symptoms you have had in the last 24 hours?


Fever / Chills                         Headache                     Sore Throat                              Loss of taste or smell           Shortness of breath          Difficulty breathing                 Cough/ Dry hacking cough


Has your child or anyone you have been in contact with experienced symptoms of COVID-19 in the last 14 days?

YES              NO


My child agrees to wear a face covering while indoors in our facility.  Children under 10 will agree to wear face coverings when around other students and staff.


I agree with the above information and have answered to the best of my ability.


Adult signature: _____________________________________