LCSD Community Education Daily Health Screening

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Each Community Education participant shall complete this screening before each time they will be entering a district facility for a course.

If the answer is YES to any of the questions below, you are expected to leave the building immediately and contact your supervisor for further instructions.

FIRST NAME *

LAST NAME *

Phone number *

Today's Date *

YYYY

Please indicate which building you will be attending your course in tonight. *

Como Park Elementary

Court Street Elementary

Hillview Elementary

John A. Sciole Elementary

Central Avenue Elementary

William Street School

Lancaster Middle School

Lancaster High School

Other:

Have you been in close contact with anyone who tested positive for COVID-19 or suspected of having COVID-19 in the past 10 days? *

Yes

Have you tested positive for COVID-19 in the past 10 days? *

Yes

Have you experienced symptoms of COVID-19 such as fever (temperature of 100° F or above) or chills, muscle or body aches, cough, shortness of breath, or difficulty breathing, fatigue, headache, sore throat, nasal congestion or runny nose, nausea or vomiting, diarrhea, or new loss of taste and/or smell in the past 10 days? Answer “Yes” only if you are experiencing a new onset of symptoms OR you are experiencing a change in symptoms from your baseline if you have a known pre-existing medical condition (e.g. asthma, allergies). *

Yes

Is your temperature 100° F or greater today? *

Yes

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