COVID-19 EMPLOYEE SELF-SCREENING QUESTIONNAIRE
In an effort to reduce the risk of COVID-19 exposure, all Clarkston Schools employees present on school grounds must complete the following daily screening questions.

An answer of “Yes” to any of these questions or if you have a temperture  greater than 100.4 do not report to work and contact your Supervisor immediately.

Staff screening checklist
https://www.oakgov.com/covid/supplements/!Compliance%20Toolkit%20-%20Health%20Order%2007.pdf

Symptoms of Coronavirus
https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

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Email *
EMPLOYEE FIRST NAME *
EMPLOYEE LAST NAME *
Which building(s) will you be going to? (Choose all buildings you are entering that day) *
Required
Date In the CCS Facility *
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DD
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YYYY
Do you have any of the following symptoms: New cough, shortness of breath, difficulty breathing, new loss of taste or smell, fever (over 100.4 F), chills, muscle aches, headache, sore throat, fatigue, diarrhea (2x in 24 hours), nausea or vomiting (2x in 24 hours), congestion or runny nose?       *
In the past 14 days, have you been within 6 feet for 15 minutes with a person diagnosed with COVID-19? *
A copy of your responses will be emailed to the address you provided.
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