COVID 19 Form for Building Access

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In order to follow the recommendations of the Department of Health, employees of Pocono Mountain School District will be required to complete this form before entering any building at the school district. Employees must take their temperatures at home before entering the building that day and record it in section 2 of this form. All information will remain confidential.
Thank you for your cooperation.
Mr. W. Bradley Pensyl, Executive Director of Student and Support Staff Services

First and Last Name *

Phone Number *

Email *

Which building are you entering *

Name of supervisor that approved your entry *

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