Westampton Adult Ed Student One Time Communicable Disease Policy Review and Protocol Sign Off
Dear Adult Education Student,

Please review and complete the information below prior to the start of your program.  

Thank you,

Mr. Pappler
Sign in to Google to save your progress. Learn more
Student Name (First and Last) *
Campus - Westampton *
Required
Program - Please select from the drop down list *

As per the District’s Communicable Disease Policy #8451, “The control of the spread of a communicable disease is essential to the well-being of the school community and to the efficient operation of the schools.” 

 Please complete and submit this one-time form prior to the start of your program as acknowledgement of the following:

1.    I acknowledge that I have clicked on the District Communicable Disease Policy #8451 and have read the policy which now addresses any and all communicable diseases.

2.    I understand that if I exhibit symptoms which are aligned with those of communicable diseases such as COVID-19 or Monkeypox, I must self-monitor and self-quarantine in accordance with the Burlington County Department of Health and CDC.  Questions may be directed to the school nurses and/or district contact tracer.

3.    I understand that certain illness symptoms may put students or employees at the risk of spreading illness to others. I understand that the district may exclude from the school building any staff or student who appears to be ill or has been exposed to a communicable disease which would follow a quarantine schedule outlined by the Burlington County Department of Health and CDC.

4.    I understand that a student may be isolated in school and the medical inspector, school nurse and/or another staff member may recommend that they be sent home because of exhibiting symptoms of a communicable disease.

5.    I understand that the student may not be readmitted to his/her classroom until he/she presents written evidence of clearance from a qualified physician. 

6.    I acknowledge that the district has established protocols to control communicable diseases in the classroom and school district such as signage and reminders of all in schools to wash their hands frequently and that rooms and buildings will be cleaned and disinfected daily.


Select "Yes" in the dropdown to verify that all information on this form is correct to the best of your knowledge and to sign off as an acknowledgement of the information above.  Click submit when finished. 
*
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of BurlCoSchools. Report Abuse