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Student / Staff Health COVID-19 Screening Assessment
IF YOU RESPOND 'YES' TO ANY OF THE QUESTIONS BELOW, DO NOT REPORT TO TRAINING, CALL YOUR INSTRUCTOR AND INFORM THEM OF THE SITUATION.
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BEFO
Annual HMFRO
Apparatus Operator - Pump
Apparatus Operator - Emergency Vehicles
IFO
HazMat Tech Module 2
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Have you had any signs or symptoms of a fever in the past 24 hours such as chills, sweats, felt "feverish" or had a temperature that is elevated or of 100.4F or greater? *
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Yes
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Do you currently have any of the following symptoms? *Cough *Sore Throat *Body Aches *Diarrhea *Vomiting *Shortness of Breath or Chest Tightness *Loss of Taste and/or Smell *Nausea *Fever/Chills/Sweats *
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Yes
No
Have you traveled internationally or outside of state in the last 14 days? Or, have you had any close contact in the last 14 days with someone with a diagnosis of COVID-19? *
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Yes
No
Have you been exposed to anyone that has tested positive for COVID-19, or has been issued a quarantine for COVID-19 in the last 14 days? *
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Yes
No
Self-Affirmation of Temperature
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I attest that prior to reporting to training today; my personal temperature reading was below 100.4 degrees. If I don't take my own temperature it will be taken when I arrive for work daily.
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A copy of your responses will be emailed to the address you provided.
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