VISITOR COVID-19 Symptom Report
Please complete this form PRIOR to entering any Forrestville Valley school building.
First Name *
Last Name *
Company Name *
Phone Number *
Work Location/Department *
Do you currently have any of the following symptoms? (Fever of 100.4 or higher, chills, muscle or body aches, cough, shortness of breath/ difficulty breathing, new loss of taste or smell, nausea, vomiting or diarrhea, fatigue, headache, sore throat, congestion or runny nose) *
Please select one:
By clicking "I agree" below you are agreeing that you will not enter our buildings and will notify staff if you are exhibiting any of the above symptoms. *
Required
Have you or anyone in your home been diagnosed or in close contact with someone with COVID-19 or been directed to quarantine? *
By clicking below I am agreeing to notify staff if anyone in my home or someone I have been in close contact with has been diagnosed with COVID-19 or directed to quarantine. *
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of Forrestville Valley School District 221. Report Abuse