Forms → Staff → Enrollment → Health Screenings
Form number: SR-5
Last revised: February 2019
This is a sample of the SR-5, Health Screenings card, and is for reference only. Schools should complete a SR-5 card for each student on the yellow card stock version of this form ordered through the Department of Materials Management.
Student Record Card 5 (SR-5) is used for recording health information concerning a student.
Forms require Adobe Acrobat Reader 8 or higher. Get Acrobat