JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Daily COVID-19 Screening
To keep you and all of our employees and students safe, every employee must be assessed for COVID-19 symptoms and risk factors each day before starting work. The survey must be complete at or before the beginning of your workday before you begin working. IMPORTANT: If you answer "Yes" to any of the questions, you must immediately contract your direct supervisor or school personnel to notify them and follow the proper requirements and guidelines.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Building
*
HWECC
Gladiola
West
Parkview
Oriole Park
WRC
Wyoming Intermediate
Wyoming Junior High
Wyoming High School
Transportation/Operations Office
Administration Building
Have you had a fever greater than 100.4 degrees Fahrenheit in the last 3 days or do you currently have a fever of 100.4 or higher, feel feverish or have chills?
*
Yes
No
Do you have any of the following symptoms that have started or gotten worse in the last 24 hours? Sore Throat, New Cough or change in Cough, Diarrhea, Vomiting or Belly Pain, New Severe Headache, Loss of Taste or Smell.
*
Yes
No
Have you been tested and laboratory results showed that you are positive for COVID-19 in the last 14 days?
*
Yes
No
To your knowledge, in the past 14 days, have you had close contact (within 6 feet for 15 minutes or more) with someone who has tested positive for COVID-19?
*
Yes
No
IMPORTANT: If you have answered "Yes" to any of the questions above, you must immediately contact your direct supervisor for further guidance. Do not continue into the building.
*
I understand the above statement
By typing my name below, I attest that I have answered the above questions truthfully and honestly.
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Wyoming Public Schools.
Report Abuse
Forms
