SESS Contractor COVID 19 Daily Self Checklist
Please fill out form prior to evaluation and daily prior to reporting to work.

If you reply YES to any of the questions below, STAY HOME and follow the steps below:

Step 1: Notify your school administrator
Step 2: Notify your SESS Lead Supervisor if SESS employee
Step 3: Notify your health care provider
Step 4: Provide SESS with doctor's documentation of medical release to return to work,

If you start feeling sick during your school day, follow steps 1 and 2 above and leave work immediately.

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Email *
Your Name *
Name of Charter Campus *
Date: *
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Do you have a fever (temperature over 100.3 F) without having taken any fever reducing medications? *
Do you have NEW loss of smell or taste? *
Do you have muscle aches? *
Do you have a sore throat? *
Do you have a cough? *
Do you have shortness of breath? *
Do you have chills? *
Do you have a headache? *
Have you had a new rash? *
Have you experienced any gastrointestinal symptoms such as nausea/ vomiting, diarrhea, loss of appetite? *
Have you, or anyone you have been in close contact with been diagnosed with COVID-19, or been placed on quarantine for possible contact with COVID-19 in last 14 days? *
Have you been asked to self-isolate or quarantine by a medical professional or a local public health official in the last 14 days? *
A copy of your responses will be emailed to the address you provided.
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