IMS Employee COVID-19 Self-Screening Daily Log
Every morning, before coming to work, IISD employees are expected to self-screen using the symptoms below. Fill out this form and note any symptoms you are currently feeling. If you answer yes to either question below, contact your campus administrator immediately after submission.  *Remember this is not an exhaustive list. List is provided by CDC/TEA.
Sign in to Google to save your progress. Learn more
Have you been lab-confirmed with COVID-19? Or within the last 14 days, have you come into close contact with an individual who is lab-confirmed with COVID-19? *
Have you recently begun experiencing any of the following (Temp of 100.4 or higher; Sore throat; New uncontrolled cough that causes difficulty breathing (or, for those with a chronicallergic/asthmatic cough, a change in their cough from baseline); Diarrhea, vomiting, or abdominal pain; or New onset of severe headache, especially with a fever) in a way that is not normal for you? *
If YES to any of the symptoms above, what date did you first start experiencing these symptoms:
MM
/
DD
/
YYYY
If YES to any of the symptoms above, approximately what time did you first start experiencing these symptoms (best approximate time possible):
Time
:
Role on IMS Campus *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Ingram ISD. Report Abuse