21-22 Employee Agreement To Self-Screen

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Employees are asked to complete this form on the first of each month, as confirmation that daily self-screenings are being performed.

Email *

Last name *

First name *

Building (that you primarily work in) *

CEA

TRA

BUS

Other:

By completing this form, you commit to self-screen daily. The presence of any of the symptoms below generally suggests an individual has an infectious illness and should not report to school, regardless of whether the illness is COVID-19.

For employees with chronic conditions, a positive screening should represent a change from their typical health status.

Daily symptom screening should not try to identify every known symptom of COVID-19. No single symptom indicates someone has COVID-19, and many COVID-19 symptoms can occur when a person does not have COVID-19 or any infectious illness. Instead, use symptom screening to determine if an employee currently has an infectious illness that they might pass on to others.

Please use this space to provide other information if appropriate.

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