COVID-19 Self-Screening Form

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This form lets you tell us that you are not safe to be at campus based on a self-screening at home, and helps us understand why you cannot attend so that we take the appropriate steps to keep everyone safe and support you.

Email *

Student Name / Nombre del estudiante *

Best contact information for follow up. / La mejor información de contacto para seguimiento. *

In the self-screening at home I answered YES to these questions, and so I can NOT safely come to campus for school. / En la autoevaluación en casa, respondí SÍ a estas preguntas, por lo que NO puedo ir a la escuela de manera segura. *

I have experienced one or more PRIMARY symptom of COVID-19 in the last 5 days / He tenido uno o más síntomas PRIMARIOS de COVID-19 en los últimos 5 días

SOMEONE ELSE in my household has experienced one or more PRIMARY symptoms of COVID-19 in the last 5 days. / ALGUIEN MÁS en mi hogar ha tenido uno o más síntomas PRIMARIOS de COVID-19 en los últimos 5 días.

I have been in close contact with someone who has a positive case of COVID-19 in the last 5 days. / He estado en contacto cercano con alguien que tiene un caso positivo de COVID-19 en los últimos 5 días.

Required

Do you plan to, or have you already had a COVID-19 test? *

I have been tested - I do not know my results yet / Me han hecho la prueba, todavía no conozco mis resultados

I have been tested and got a negative result / Me hicieron la prueba y obtuve un resultado negativo.

I have been tested and got a positive result / Me hicieron la prueba y obtuve un resultado positivo.

I do not plan to get tested / No planeo hacerme la prueba

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