Pivot San Diego Site: Student Daily Check-in Form
This form must be completed for every student, EVERY DAY they are on site for any length of time.

Students and their parents/guardians may complete the screening questions on this form in advance, before traveling to the site, as long as responses are submitted on the same day. Responses submitted on a previous date will not be accepted. Every student will have their temperature taken when arriving to the site. Pivot staff members will review responses to this form, and every student must be cleared by Pivot staff each day before entering the building.

If the student does not meet the screening requirements or if a student has a temperature at or above 100 degrees Fahrenheit, or if they refuse to comply with site rules and regulations, they will NOT be allowed to enter the site.
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Full name of student checking in: *
Screening Requirements
Requirement 1: In the past 24 hours, you have not had any of the following symptoms that are not caused by another condition: sore throat, cough, headache, congestion, nausea or vomiting, diarrhea, chills, body aches, chest pain, fatigue, shortness of breath, loss of smell, loss of taste, or fever at or greater than 100 degrees Fahrenheit.

Requirement 2: You have not had a positive COVID-19 test, in the past 10 days as a result of exposure or symptoms.
Site rules and regulations
All students must comply with the following rules and regulations:
1. Practice social distancing as much as possible and as instructed.
2. Use hand sanitizer and sanitizing wipes, including whenever prompted by Pivot staff members.
3. Follow safe hygiene practices such as washing hands regularly, including whenever prompted by Pivot staff members.
Please note that face masks are Strongly Recommended.
By hitting submit, the student agrees to comply with all site rules and regulations listed above and certifies that they have met the screening requirements.   Untitled Title
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