This form should be filled out by any staff member who is experiencing symptoms of COVID-19 or who fails the self-screening by answering "yes" to any of the following questions:

1. Within the past 24 hours have you had a fever (100.4 and above) or used any fever-reducing medicine?
2. Do you feel sick with any of the high risk symptoms of COVID listed below?
3. Have you been a close contact of a person with COVID in the past 14 days?

You should stay home with any YES response to the questions above OR with two or more of the "lower risk" symptoms listed below:

Low-Risk Symptoms:
 New Headache
 Muscle Pain
 Runny Nose/Congestion
 Nausea/Vomiting/Diarrhea
 Any Above Beyond Typical Symptoms (i.e. Allergies)


High-Risk Symptoms:
 New, Uncontrolled Cough
 Shortness of Breath/Difficulty Breathing (not exercise-induced asthma)
 New Loss of Taste/Smell
 Fever 100.4 or Higher
 Chills
 Sore Throat

If you don't feel that these symptoms are related to COVID-19 you should call in sick using our normal procedures.