TEANECK PUBLIC SCHOOLS - COVID-19 Staff Screening Questionnaire

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Kindly complete the following questionnaire daily prior to entering any Teaneck Public School Building. If you answer "Yes" to any of the following questions, please contact both the School Nurse on duty and your Direct Supervisor, immediately.

Recent travelers to any of the states listed in New Jersey's Travel Advisory List or any international destinations where travel is limited by government orders are to monitor themselves for COVID-19 related symptoms. Please note, the district reserves the right to ask you to quarantine should the need occur.

The phone number to the School Nurse at THS is 201-833-5420. The phone number to the School Nurse at Bryant is 201-833-5549.

Name *

Title *

Vendor

District Employee

Visitor

Required

Department/School *

Are you experiencing any of the following symptoms? *

Yes

Fever of 100.4°F or above

Cough or shortness of breath

Sore Throat

Chills

Muscle aches or rigors (body aches)

Headache

New loss of taste or smell

Abdominal pain, nausea, vomiting or diarrhea

Have you tested positive for COVID-19 in the past 14 days? *

Yes

To the best of your knowledge have you knowingly been in close or proximate contact in the past 14 days with anyone who has tested positive for COVID-19. *

Yes

Other:

Certify *

I certify that the above responses are true and correct to the best of my knowledge. I understand that I subject myself to disciplinary action in the event that the above responses are found to be falsified.

Required

Submit

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