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Daily Self-Screening Checklist
Complete the Daily Self-Screening Checklist prior to entering any Webster Groves School District building.
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If you are a Webster Groves School District employee and answer YES to ANY of these questions, do not report to work and immediately contact your direct supervisor.
If you are a guest of Webster Groves School District and answer YES to ANY of these questions, immediately leave the facility and follow the protocol established by your employer and/or health care provider.
First Name and Last Name
Your answer
Do you have a new fever of 100.4 or greater?
Yes
No
Clear selection
Building
Ambrose
Avery
Bristol
Clark
Edgar Road
Givens
Hixson
Hudson
Service Center/TLC
Steger
Warehouse
WGHS
WGSD-CO
Clear selection
Are you currently experiencing diarrhea symptoms?
Yes
No
Clear selection
Are you currently experiencing congestion and/or runny nose?
Yes
No
Clear selection
Are you currently experiencing nausea or vomiting?
Yes
No
Clear selection
Do you have a new cough that you cannot attribute to another health condition?
Yes
No
Clear selection
Are you currently experiencing shortness of breath or difficulty breathing that you cannot attribute to another health condition?
Yes
No
Clear selection
Are you currently experiencing any loss of taste or smell?
Yes
No
Clear selection
Are you currently experiencing a headache that you cannot attribute to another health condition?
Yes
No
Clear selection
Do you have new muscle or body aches that you cannot attribute to another health condition or that may have been caused by a specific activity (such as physical exercise)?
Yes
No
Clear selection
Are you currently experiencing a fever or chills?
Yes
No
Clear selection
Have you had any close contact with a person who demonstrated any of the above symptoms?
Yes
No
Clear selection
Have you had any close contact with a person who has a suspected or confirmed case of COVID-19?
Yes
No
Clear selection
Have you been tested for COVID-19 and are awaiting results?
Yes
No
Clear selection
Have you tested positive for COVID-19?
Yes
No
Clear selection
Have you traveled outside the United States by air or cruise ship in the past 14 days?
Yes
No
Clear selection
If yes, please list the date(s).
Your answer
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