OACSD Visitor Screening
By answering the questions below, I acknowledge that I have self-screened prior to coming onto the OA Campus and have not misrepresented my health in any way to the Owego Apalachin Central School District.  I further understand that if the answer is YES to any of the questions above, I am NOT ALLOWED on school grounds and need to contact my health care provider immediately.

Sign in to Google to save your progress. Learn more
Email *
First Name *
Last Name *
Department/Building I am Visiting *
Have you knowingly been in close or approximate contact in the last 10 days with anyone who has tested positive, through a diagnostic test, for COVID-19 or are you currently in a mandated quarantine? Please Note: If you’ve received the full dose of the vaccine and are beyond the 14 day post vaccination period; and/or you are within 90 days of a laboratory confirmed positive test then you may answer “no” to this question. *
Have you tested positive through a diagnostic test for COVID-19 in the past 14 days? *
Have you experienced new or worsening symptoms of COVID-19, including being extremely tired, dry cough, shortness of breath, loss of sense of smell or taste, nausea, vomiting, or diarrhea, or fever of over 100.0°F, over the past 10 days? *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Owego Apalachin CSD. Report Abuse