Kingston Covid-19 Health Screening Questionnaire
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Name: *
What is the date? *
MM
/
DD
/
YYYY
What is the time? *
Time
:
What is your purpose for being in the building?
Do you feel ill today? *
Do you have a cough? *
Do you have a fever? *
If you answered yes to any of the three questions above, please do not enter the building, unless you are an employee and you know that your current symptoms are unrelated to COVID-19, for example seasonal allergies, or other known recurring symptom/s.
By clicking "Agree", you are agreeing to the following:
1.  Apply hand sanitizer upon entering the building
2.  Wipe down any copying machine or device you touch while in the building.
3.  Practice social distancing of at least 6 feet apart.
4.  Practice washing hands often, coughing/sneezing into a tissue and avoid touching
your face while on school property.
I agree to the 4 statements above. *
Thank you and stay safe KCS staff!
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