September NBC Employees Covid Questionnaire/Statement reporting to Mr. McKee.
All employees are directed to complete this form each day.   Responses to these questions will be automatically recorded and stored.  These responses will only be available to your direct Supervisor, the Superintendent, his designees, and NBC's school physician.
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Last Name *
First Name *
SECTION 1:    Symptoms
Any of the symptoms below could indicate a COVID-19 infection and may put you at risk for spreading illness to others. Please note that this list does not include all possible symptoms and people with COVID-19 may experience any, all, or none of these symptoms.
COLUMN A.                Please  select symptoms:
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COLUMN B.           Please  select symptoms:
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People who are sick (e.g. fever, vomiting, diarrhea) should not attend school in-person.  
 If TWO OR MORE of the fields in Column A are checked off    OR    AT LEAST ONE field in Column B is checked off, please stay home and notify the school for further instructions.
SECTION 2:   Close Contact/Potential Exposure.  
Please select if:
If ANY of the fields in SECTION 2 are selected, you should remain home for 14 days from the last date of close contact exposure or date of return to New Jersey.
Contact your provider or your local health department for further guidance.
Based on your responses to symptoms and exposure above, will you report to work today? If NO, please contact your supervisor for further information. *
By submitting this form I acknowledge that I have provided accurate information.
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