Dover High School & Regional Career Technical Center COVID-19 Student Screener
PURPOSE: To protect all employees, students and visitors, we are requiring that you complete this questionnaire.


This form will change based on current knowledge surrounding COVID-19.
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Email *
Last Name *
First Name *
If you answer YES to any of the below questions, you will not be allowed access into the building
If you answer YES to any of the below questions, it is recommended to speak with the school nurse and your primary care physician.
NH DPHS quarantine guidance for people who are fully vaccinated or previously infected with SARS-CoV-2 has been updated (Quarantine Guide). This guidance applies to the general public, businesses, schools, and healthcare facilities, including long-term care facilities (LTCFs) and assisted living facilities (ALFs).
The following people do NOT need to quarantine after an exposure to a person with COVID-19, or after international or cruise travel:  A) A person who is 14 days beyond the final dose of their COVID-19 vaccine and considered fully vaccinated (i.e., 14 days after “full vaccination”). B) A person who is within 90 days of a prior COVID-19/SARS-CoV-2 infection diagnosed by PCR or antigen testing.
1. Body Temperature –  If 100.0° or higher, you will not be allowed access into the building even if you have had COVID (within 90 day) or are fully vaccinated. *
2. Do you have any NEW or UNEXPLAINED signs or symptoms of a respiratory illness, or any of the following symptoms even if you have had COVID (within the past 90 days) or are fully vaccinated?  (Fever above 100.0*, cough, congestion, chills, shortness of breath or difficulty breathing, runny nose, sore throat, headache, diarrhea, muscle pain/body aches, nausea/vomiting, new loss of taste or smell)  Explained symptoms are symptoms you have a reason for (muscle ache after flu-shot, runny nose caused by seasonal allergies).  Medical documentation must be provided as proof of an explained symptom. *
3. In the last 10 days, have you had ‘close contact’ with someone with a confirmed diagnosis of COVID-19, or who is under investigation by NH DHHS for COVID-19?  (If you have been either diagnosed with COVID-19 via Antigen or PCR test within the past 90 days OR are 14 days past your ‘full vaccination’ of the COVID-19 vaccine, please answer NO to this question).  The elements of a ‘close contact’ is detailed in the Protocols Applied to Pandemic Education document located on the Dover School District SAU#11 website. *
4. Is there a person in your household currently waiting for a COVID-19 test result because they are symptomatic? (If you have been either diagnosed with COVID-19 via Antigen or PCR test within the past 90 days OR are 14 days past your ‘final dose’ of the COVID-19 vaccine, please answer NO to this question). *
5. In the last 10 days, did you travel internationally or on a cruise ship?   If YES, you will be required to complete a quarantine upon arrival to NH for ten days, unless diagnosed with COVID-19 in the prior 90 days or “fully vaccinated” against COVID-19.  Students and staff that are required to quarantine after international travel or travel on a cruise ship can choose to end quarantine after 7 days if the person is asymptomatic, and has a negative PCR-based test that is collected on days 6-7 of quarantine. *
If you have answered YES to any of the above questions, you will not be allowed access to the building.
Checking YES below acts as your digital signature. *
A copy of your responses will be emailed to the address you provided.
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