Request edit access
COVID Attestation - Endeavour Intermediate
To help keep our students, staff, families, and community safe and healthy, each person entering a Fife School District building must complete this survey. This attestation needs to be completed each day, prior to any individual accessing district facilities.
* Required
Email address
*
Your email
Name
*
Your answer
Primary Phone Number
*
Your answer
I am a :
*
Staff Member
Visitor
Vendor
Other:
Required
Do you have any of the following symptoms that are not caused by another condition? (Fever (100.4°F) or chills, cough, shortness of breath or difficulty breathing, unusual fatigue, muscle or body aches, headache, recent loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, or diarrhea)
*
Yes
No
Does anyone in your household have any of the above symptoms that are not attributable to another condition?
*
Yes
No
Has a Health Care Provider or Health Official asked you or someone in your household to isolate or quarantine in the last 14 days?
*
Yes
No
Have you or your student had any medication to reduce a fever before coming to school in the last 10 days?
*
Yes
No
If you answered YES to any of the above questions, please leave the building and follow-up via email or phone.
Send me a copy of my responses.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Fife School District.
Report Abuse
Forms