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TMS Staff Health Screening
Complete this form prior to returning to school.
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Symptoms
Do you have any of the following new or worsening symptoms of possible COVID-19?
Cough
*
Yes
No
Diarrhea
*
Yes
No
Sore Throat
*
Yes
No
Loss of taste or smell
*
Yes
No
Headache
*
Yes
No
Muscle Pain
*
Yes
No
Chills
*
Yes
No
Repeated shaking with chills
*
Yes
No
Shortness of breath or difficulty breathing
*
Yes
No
Feeling feverish or a measured temperature greater than or equal to 100.0 degrees Fahrenheit
*
Yes
No
Known close contact with a person who is lab-confirmed to have COVID-19
*
Yes
No
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