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Rudyard Area Schools - Self Declaration Form -
The safety of our employees, educators, families, and visitors remains our overriding priority. As the coronavirus disease (COVID-19) outbreak continues to evolve and spreads globally, Rudyard Area Schools is monitoring the situation closely and will periodically update organization guidance based on current recommendations from the Center for Disease Control and the World Health Organization.

To prevent the spread of COVID-19 and reduce the potential risk of exposure to our employees and visitors, we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measures to protect you and everyone in our buildings. Thank you for your time.

If the answer is "yes" to any of the following questions, please contact your supervisor immediately.
Name *
Have you traveled to any other country or state in the last 14 days? If you answer yes, please contact your supervisor immediately. *
Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days? If you answer yes, please contact your supervisor immediately. *
Have you been in close contact with anyone who has traveled to any other country or state within the last 14 days? If you answer yes, please contact your supervisor immediately. *
Have you experienced any cold or flu-like symptoms in the last 14 days (to include fever, cough, sore throat, respiratory illness, difficulty breathing)? If you answer yes, please contact your supervisor immediately. *
What is your temperature today? * *
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