COVID 19 screening form - Hopatcong Schools
By entering any school buildings within the Hopatcong Borough School District you affirm the following (as a staff member or on behalf of your child(ren) attending school):

a) You (or the student) have not in the last 14 days had any close contact with anyone who is either confirmed or suspected of being infected with COVID-19, including anyone who was experiencing or displaying any of the known symptoms of COVID-19 (listed below); AND

b) You (or the student) do not currently experience or display, and you have not in the last 10 days experienced or displayed, any of the following symptoms:

- elevated temperature or fever of 100.4 or higher
- cough
- chills or shaking
- shortness of breath and/or difficulty breathing
- loss of smell and/or taste
- fatigue/muscle aches
- persistent headaches
- nausea or vomiting
- diarrhea
- sore throat
- congestion/runny nose

c) You (or the student) have not traveled out of the country in the last 10 days.
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Your Name (Last Name, First Name)/ Names of your student children (Last Name, First Name) *
Your school (where you work or your children attend) - Check all that apply *
Required
After reading the message above I (my children) are approved to attend work/school*. (*PLEASE NOTE THAT IF YOU CANNOT ANSWER "YES" YOU SHOULD NOT COME TO SCHOOL AND YOU SHOULD CONTACT THE SCHOOL NURSE) *
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