COVID-19 Symptom Self Report - RGSD
This form will be used daily in lieu of symptom checking upon your arrival to a location or locations in Riverview Gardens School District. This information will only be used in the event we need to contact you due to COVID-19 exposure.
Please type your name.
Your reason for visiting campus?
Collecting belongings, gathering supplies, etc.
Work - district employee
Work - contractor
Are you experiencing any of the following symptoms today? If you have any of these symptoms, STAY HOME. If you are scheduled to work, report your absence as usual. Check all that apply.
I am not experiencing any of the symptoms listed.
Fever of 100.4 or greater in the past 14 days
Shortness of breath or difficulty breathing
Loss of sense of smell or taste
Have you been exposed to any confirmed or suspected cases of COVID-19 within the past 14 days? If you answer YES to this question, STAY HOME. If you are scheduled to work, report your absence as usual.
What location or locations will you be at today? Select all that apply. If you will work in more than one location today, please select all applicable locations.
Central Middle School
Lewis & Clark Elementary
Michelle Obama Early Childhood Academic Center
Riverview Gardens High School
Westview Middle School
Send me a copy of my responses.
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This form was created inside of Riverview Gardens School District.