Lincoln Consolidated Screening Check
This form should be completed by anyone who is entering a Lincoln Consolidated Schools building effective July 1, 2020.

If you have a temperature above 100.4, have any COVID symptoms, have had close contact with a COVID positive person in the last 14 days, or have traveled outside the country in the last 14 days, do not report to work and communicate that you will not be at work to your supervisor.

All staff, contractors, and students are required to keep a face covering in their possession while inside a Lincoln Consolidated Schools building. The face covering must be worn while indoors and in the presence of another person, or when outdoors and within close contact of another person (defined as within 6 feet).
Email address *
Last Name *
First Name *
Please provide your contact phone number. *
What building will you be entering? *
Required
What is today's date? *
MM
/
DD
/
YYYY
What time are you entering the building? *
Time
:
I have taken my temperature and it was below 100.4 degrees *
Do you have new symptoms of fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea? *
In the last 14 days have you tested positive for COVID-19, or been in contact withanyone suspected or confirmed to have COVID-19? *
Have you traveled outside the U.S. in the last 14 days? *
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