COVID-19 Screening Form
Due to the COVID-19 pandemic, and in an attempt to minimize the spread of the virus, the District is required to screen all visitors entering and leaving a school facility. In order to be granted access to District facilities, all visitors must truthfully complete and submit the following:
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Please enter your Visitor Description: *
Please enter your name: (Last Name, First Name) *
Please enter your Visitor Location: *
In the past 10 days, I have not exhibited any of the known symptoms of COVID-19, including: feeling feverish (chills, significant muscle pain or aches, shaking or exaggerated shivering) or a measured temperature greater than or equal to 100.0 degrees Fahrenheit, loss of taste or smell, cough, difficulty breathing (or, for individuals with a chronic allergic/asthmatic cough, a change in their cough from baseline), shortness of breath, sore throat, congestion or runny nose, headache, fatigue, nausea, vomiting, or diarrhea. *
In the past 10 days, I have not been in close contact with any person known to have an active COVID-19 diagnosis who has not been cleared from quarantine. *
If any of the answers to the questions above are yes, you cannot be present on campus until you are not experiencing any symptoms for 10 consecutive days.
Disclaimer:
While on District property I will strive to maintain a minimum of 6 feet of separation from any other individuals not within my household.

I understand that schools are required to comply with the Governor’s executive order regarding the wearing of masks. I will wear a cloth face covering (over the nose and mouth) or non-medical grade face mask or a face shield. Exceptions include: impractical situations such as when a person is consuming food or drink, when a congregating group of persons maintains at least 6 ft of social distancing, any person with a medical condition or disability that prevents wearing a face covering, or any other reason or circumstance indicated under the executive order. I also understand that I must strive to follow the minimum standard health protocols issued by the Texas Department of State Health Services and cited by the Texas Governor in his Executive Orders related to the pandemic.

I understand that the virus that causes COVID-19 can be spread to others by infected persons who have few or no symptoms. Even if an infected person is only mildly ill, the people they spread it to may become seriously ill or even die, especially if that person is 65 or older or has pre-existing health conditions that place them at higher risk.

I understand that the District cannot guarantee that I will not contract the virus, even when implementing screening protocols and safety standards. I acknowledge that I am assuming the risk that I may contract the virus by entering District facilities, even when screening protocols and other required safety measures are implemented.
I understand that the Van Vleck Independent School District is voluntarily permitting me to [visit campus] on the basis that I have truthfully made the above statements, and I choose YES below to confirm my understanding of the above.
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