Transportation_Daily Health Screening

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Please fill out the following form and indicate if you have had any of the following symptoms or exposures.

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Name *

Assignment *

Building *

Symptoms

Temperature 100 degrees Fahrenheit or higher when taken by mouth.

Sore Throat.

New uncontrolled cough that causes difficulty breathing (for students with chronic allergic/asthmatic cough, a change in their cough from baseline)

Diarrhea, vomiting, or abdominal pain.

New onset of severe headache, especially with a fever.

New loss of taste or smell.

Exposure

Within the last 10 days have you been diagnosed with COVID-19, had a test confirming you have the virus, or been advised to isolate by your doctor or a public health official?

In the last 10 days were you identified as a close contact of someone who tested positive for COVID-19 and/or advised to quarantine? DO NOT CHECK THIS BOX IF YOU HAVE BEEN FULLY IMMUNIZED (>2 weeks since the final dose of the vaccination series) OR YOU HAVE TESTED POSITIVE FOR COVID-19 WITHIN THE PAST 3 MONTHS.

Have you returned from travel within the past 10 days? This includes travel from outside of the country or any area outside of the immediate region (NY, PA, CT or DE) for more than 24 hours. DO NOT CHECK THIS BOX IF YOU HAVE BEEN FULLY IMMUNIZED (>2 weeks since the final dose of the vaccination series) OR YOU HAVE TESTED POSITIVE FOR COVID-19 WITHIN THE PAST 3 MONTHS.

If you checked any of the boxes above, you are not approved to work. Please contact your supervisor.

I confirm that my answers to all of the above are true and accurate. *

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