Ingram Middle School Visitor COVID-19 Self-Screening Tool / Ingram Middle School COVID-19 Herramienta de auto-detección
IISD visitors are required to self-screen for the COVID-19 virus, using the provided symptom list below. Fill out this form by checking either Yes or No based on the way you are currently feeling. Our office will get notice of your self-screen submission and be with you shortly. Thank you for helping to keep our students and staff safe! / Se requiere que los visitantes del IISD realicen una auto-detección del virus COVID-19, utilizando la lista de síntomas provista a continuación. Complete este formulario marcando Sí o No en función de cómo se siente actualmente. Nuestra oficina recibirá un aviso de su presentación de auto-pantalla y estará con usted en breve. ¡Gracias por ayudar a mantener seguros a nuestros estudiantes y al personal!
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This form is ONLY for Ingram Middle School Visitors & Students. If you are visiting the Elementary School or the High School campus, you must complete those forms separately for each campus. / Este formulario es ÚNICAMENTE para Visitantes & Estudiantes de la Escuela Intermedia Ingram. Si está visitando el campus de la escuela primaria o secundaria, debe completar esos formularios por separado para cada campus.
Visitor's Email Address / Dirección de correo electrónico del visitante
Visitor's Full Legal Name / Nombre legal completo del visitante *
IMS Student's Name / Nombre de IMS Estudiante
Date: *
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/
DD
/
YYYY
Reason for visiting IMS campus / Motivo para visitar el campus de IMS: *
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?   / ¿Ha sido confirmado en laboratorio con COVID-19? En los últimos 14 días, ¿ha estado en contacto cercano con una persona que ha sido confirmada en laboratorio con 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? *
Thank you! / ¡Gracias!
Once you have submitted this form, our office staff will quickly receive the verification of your self-screening and be with you shortly. We appreciate your support in keeping our campus, students, and staff safe. / Una vez que haya enviado este formulario, el personal de nuestra oficina recibirá rápidamente la verificación de su autoevaluación y estará con usted en breve. Agradecemos su apoyo para mantener la seguridad de nuestro campus, estudiantes y personal.
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