Adult HLS Visitor COVID-19 Evaluation

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All adult visitors to HLS must complete this self-evaluation form to enter the school building.

Email *

Name *

Have you received a confirmed diagnosis for coronavirus (COVID-19) by a coronavirus (COVID-19) test or from a diagnosis by a health care professional in the past 14 days? *

Yes

Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days? *

Yes

Have you experienced any cold or flu-like symptoms in the last 14 days (to include: fever or temperature of greater than 100.4 degrees Fahrenheit/38 degrees Celsius, cough, difficulty breathing, sore throat, pressure in the chest, extreme fatigue, earache, persistent headache, diarrhea, and persistent loss of smell or taste)? *

Yes

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