Sam Houston Elem.-COVID-19 Screening

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Sam Houston Elem.-COVID-19 Screening

*This is a screening tool. If you are positive, you will need to see a doctor for further testing. You will not be allowed to return to work until you are cleared by a medical provider.

* If you have any of the COVID-19 symptoms, you will NOT be able to test on campus. Please seek medical attention.

*Mask will be required.

Sign in to Google to save your progress. Learn more

* Indicates required question

Last Name *

Your answer

First Name *

Your answer

Please provide a cell phone number for testing results. Ex: 956-555-5555 *

Your answer

If your screening results are positive, do you agree to seek medical attention? *

Yes

No

Next

Clear form

Never submit passwords through Google Forms.

This form was created inside of Weslaco ISD. Report Abuse