Professional Learning Participant Health Survey

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All participants who are registered to attend a Green Hills AEA sponsored face-to-face professional learning workshop/course are required to complete this health survey 24-48 hours prior to the date of the scheduled professional learning. This survey is required to help ensure the safety of all participants by helping to minimize the risk of any COVID-19 exposure.

If you are experiencing any of the following symptoms, Green Hills AEA asks that you join the professional learning electronically via Zoom (*The Instructor will create the link).

Thank you for taking the time to complete this survey. Please direct any questions you might have regarding this survey to Jason Plourde, Executive Director of Universal Services and Supports, at jplourde@ghaea.org.

Email *

Name *

District *

Have you or anyone in your household had any of the following symptoms in the last 21 days - check all that apply: *

Sore throat

Cough

Body aches for unknown reasons

Shortness of breath for unknown reasons

Loss of smell

Loss of taste

Fever/chills at or greater than 100 degrees Fahrenheit

I have experienced none of these symptoms in the past 21 days.

Other:

Required

Have you or anyone in your household tested positive for COVID-19 in the last 21 days? *

Yes

Required

Have you come into close contact (within 6 feet) with someone who has a laboratory confirmed COVID diagnosis in the past 21 days? *

Yes

Required

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