Daily Health Screening for Muscatel Staff

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Students and staff are required to conduct health screenings prior to reporting to school and/or work. Checks must include a check-in concerning cough, shortness of breath, difficulty breathing and fever or chills and if the individual has had contact with a person known to be infected COVID-19 in the last 14 days.

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عنوان بريد إلكتروني *

First name *

Last Name *

School Location *

Muscatel

أخرى:

Room Number

Cell Phone Number/Contact Number *

Date Worked *

شهر

YYYY

Time In *

الوقت

Question #1: I affirm that I have been without fever for 24 hours without the use of fever-reducing medications and that I have not had symptoms of respiratory illness (cough, shortness of breath, difficulty breathing, fever, chills, or runny nose) in the past 24 hours. *

Yes

Question #2: I affirm that everyone that I live with or have been in close contact with has been without fever (100.4 or above) for 24 hours, without the use of fever-reducing medication, and that they have not had symptoms of respiratory illness (cough, shortness of breath, difficulty breathing, fever, chills, or runny nose) in the past 24 hours. *

Yes

إرسال

محو النموذج

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