Covid-19 Questionnaire
Waltrip Ram Band
This form must be filled out each time you attend an "In Person" Event as part of our Check-In Procedures.
All students, employees, and visitors must wear a mask on HISD property.
If student, employee, or visitor is exhibiting any obvious signs of illness (pallor, redness of cheeks/face, continuous coughing, shortness of breath), has been exposed to COVID-19, has a temperature greater than or equal to 100.0 ° F (37.7° C), answers yes to any of the symptoms below, or refuses to wear a mask, they will be denied entry.
* Required
Type Your Last Name
*
Your answer
Type Your First Name
*
Your answer
Type Your ID#
*
Your answer
Have you traveled out of state within the past 14 days?
*
Yes
No
Other:
If you selected yes on the previous question type where?
Your answer
Do you have a fever over 100 degrees?
*
Yes
No
Have you came in contact with someone who has a confirmed positive test for Covid-19 within the past 3 weeks?
*
Yes
No
Have you had any of the following symptoms in the past 48 hours?
*
Yes
No
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