Employee COVID-19 Self-Certification and Verification Form
In response to the COVID-19 pandemic and in order to ensure a safe and healthy environment for our school community, the June 23, 2020 Transition Joint Guidance from the Illinois State Board of Education and the Illinois Department of Public Health requires that every employee undergo a daily symptom screening prior to utilizing district transportation (bus drivers/aides etc.) or entering any district building.

Employees will conduct this daily symptom screening each day prior to their arrival for work and report consistent with the parameters outlined below, until otherwise notified by the district in writing.

                 This form must be completed and returned prior to August 14, 2020.

CERTIFICATION and VERIFICATION of DAILY SYMPTOM SCREENING: I will conduct a daily symptom screening of myself to determine if I have any of the following COVID-19 symptoms:

     -Temperature of 100.4 degrees Fahrenheit (or greater) (38 degrees Celsius);
     -Cough;
     -Shortness of breath or difficulty breathing;
     -Chills;
     -Fatigue;
     -Muscle and body aches;
     -Headache;
     -Sore Throat;
     -New loss of taste or smell;
     -Congestion or runny nose;
     -Nausea and/or vomiting;
     -Diarrhea; or
     -Any other COVID-19 symptoms identified by the CDC or IDPH

By reporting to work on any given day, I am certifying and verifying that I am not experiencing any COVID-19 symptoms. If I am experiencing any of the above symptoms at the time during my work day, I will immediately notify my direct supervisor and/or building principal, isolate myself away from other employees and students pending further direction from the district, and provide necessary information as requested.

If my daily symptom screening reveals that I am experiencing any COVID-19 symptoms, I will notify my direct supervisor and/or building principal in writing via email of my absence and the symptoms I am experiencing.

     Custodial/Maintenance Director, Larry Houberg houbergl@hcusd2.org 
     Food Service Director, Michelle Armstrong armstrongm@hcusd2.org
     RTI Coordinator, Jill Fulton fultonj@hcusd2.org 
     Special Services Director, Shelly Parsons parsonss@hcusd2.org
     Technology Director, Ben Seeman seemanb@hcusd2.org
     Transportation Director, Michelle Armstong armstrongm@hcusd2.org 

     BGS Building Principal, Molly Wepprecht wepprechtm@hcusd2.org
     HIS Building Principal, Brett Miller millerb@hcusd2.org
     LMS Building Principal, Michelle Chavers chaversm@hcusd2.org
     HHS Building Principal, Brad Elliot elliotb@hcusd2.org 

     HHS Athletic Director, Todd Schwarzkopf schwarzkopft@hcusd2.org
     LMS Athletic Director, Cara Anderson andersonc@hcusd2.org   
     
CERTIFICATION and VERIFICATION of OTHER COVID-19 RELATED EXPOSURES: I will notify the school that I will be absent pending further direction from the district if:
1) I receive a diagnosis of COVID-19;
2) I am suspected of having COVID-19;
3) I come in close contact (definition below) with an individual who tested positive for COVID-19 or is suspected of having COVID-19;  
or 4) I have traveled internationally.

If district staff contacts me to gather further information related to the reason(s) for my, I will provide the necessary information as requested.

By reporting to work on any given day, I am certifying and verifying that I am not presently subject to an isolation or quarantine protocol related to COVID-19.

For COVID-19, the CDC defines a "close contact" as "any individual who was within 6 feet of an infected person for at least 15 minutes starting from 2 days before illness onset (or, for asymptomatic patients, 2 days prior to positive specimen collection) until the time the patient is isolated."

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