Symptom Monitoring Tool

PDE provided sample School Symptom Screening Tool

Complete Daily Prior to School/Work*

Employee or Student Name:

Assigned Class/Group:

Temperature:

Are you/is the student taking any medication to treat or reduce a fever such as Ibuprofen (i.e. Advil, Motrin) or Acetaminophen (Tylenol)?

Are you/is the student experiencing any of the following?

Stay home if, you or the student:

• Have one or more symptoms in Group A OR

• Have two or more symptoms in Group B OR

• Are taking fever reducing medication.

*May be utilized as a screening tool for both at home and on-site screening practices.