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Visitor Health Check
Please fill out this form if you are planning to come in to our school. This information will be used for COVID-19 contact tracing purposes.
* The district reserves the right to manually screen any student or staff who appears ill in addition to this attestation. *
Please answer the following health questions prior to entering the building
Fever (100.4*F) or chills
Shortness of breath or difficulty breathing
Muscle or body aches
Recent loss of taste or smell
Congestion or runny nose
Nausea or vomiting
Do you have any of the symptoms listed above within the last day that are not caused by another condition?
Have you been in close contact with anyone with confirmed COVID-19 (for example, within 6ft for greater than 15 minutes) within the past 14 days?
Have you had a positive COVID-19 test for active virus in the past 10 days, or are you awaiting results of a COVID-19 test?
Within the past 14 days, has a public health or medical professional told you to self-monitor, self-isolate, or self-quarantine because of concerns about COVID-19 infection?
Optional - Remember this computer?
Yes, I plan on using this computer in the future.