Staff and Visitor COVID-19 Screening

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Name *

Staff or Visitor *

Your recorded temperature within the last hour. If your temperature is over 100.3 stay home do not enter the building. Please contact Mr. Trammell or the Office. *

Have you had a fever in the last 24 Hours? *

Are you currently on a fever reducing medication (Motrin, Tylenol, etc)? *

Have you had contact* with a person with a suspected case of COVID-19? *Contact is defined as less than 6 feet separation for more than 10 minutes without adequate personal protective equipment in the last 10 days. *

Have you had contact* with a person with a confirmed case of COVID-19? *Contact is defined as less than 6 feet separation for more than 10 minutes without adequate personal protective equipment in the last 14 days. *

Have you been sick or not feeling well in the last 2-10 days with any of the symptoms listed below?

Fever or chills

Cough

Shortness of breath or difficulty breathing

Fatigue

Muscle or body aches

Headache

New loss of taste or smell

Sore throat

Congestion or runny nose

Nausea or vomiting

Diarrhea

Thank you for your response. If you answered YES to any question please stay home. It is recommended that you contact your personal physician or local Health Department.

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