COVID-19 Self-Check Assessment for Students
The safety of the employees, students, families, clients, partners and visitors remains the Byron-Bergen Central School District's top priority. As the COVID-19 outbreak continues, we will closely monitor the situation and will periodically update our guidance based on current recommendations from New York State. If you are concerned about underlying medical conditions, please consult with your personal medical health care provider.

To prevent the spread of COVID-19 and reduce the potential risk of exposure to our workforce, we are conducting a simple screening.

Your participation is important to help us take precautionary measures to protect you and everyone in this facility. We request you complete this screening periodically when requested. Based on your response, you will be informed if your child report to school or if can enter our facilities.
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Email *
Please enter your first name (student first name): *
Please enter your last name (student last name): *
Please select the role that best describes you: *
If you are a parent/ guardian filling out this form on behalf of your child, please enter your first and last name:
Which school building do you attend? *
Have you knowingly been in close or proximate contact in the past 14 days with anyone who has tested positive for COVID-19 or who has or had symptoms of COVID-19? *
Have you visited an area identified on New York State's travel advisory list in the past 14 days? *
Have you experienced any of the following COVID-19 symptoms in the past 14 days? Fever or chills (100° or greater); Cough; Shortness of breath or difficulty breathing; Fatigue; Muscle or body aches; Headache; New loss of taste or smell; Sore throat; Congestion or runny nose; Nausea or vomiting; and/or Diarrhea. *
A copy of your responses will be emailed to the address you provided.
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