COVID-19 Questionnaire

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Every staff member (Administrator, Faculty, Director and Staff) MUST complete this daily questionnaire by 12:00 noon each day!

Every student must submit this form once a month, by the 30th of each month. You should ask these questions to yourself each day.

DO NOT COME TO THE BUILDING IF YOU WILL ANSWER "YES" TO ANY OF THESE QUESTIONS!

Last Name: *

First Name: *

Have you had COVID-19 symptoms in the past 14 days? *

Yes

Have you tested positive for COVID-19 in the past 14 days? *

Yes

Have you had close contact with a confirmed or suspected COVID-19 case in the past 14 days? *

Yes

By checking "Yes" below, you are providing your digital signature confirming that your answers are honest and complete. *

Yes

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