COVID-19 EMPLOYEE SELF-SCREENING QUESTIONNAIRE
In an effort to reduce the risk of COVID-19 exposure, all Clarkston Schools employees present on school grounds must complete the following daily screening questions.

An answer of “Yes” to any of these questions or if you have a temperture greater than 100.4 do not report to work and contact your Supervisor immediately.

Staff screening checklist
https://www.oakgov.com/covid/supplements/!Compliance%20Toolkit%20-%20Health%20Order%2007.pdf

Symptoms of Coronavirus
https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
Email address *
EMPLOYEE FIRST NAME *
EMPLOYEE LAST NAME *
Which building will you be going to? (Choose the 1st building you are entering that day) *
Required
Date In the CCS Facility *
MM
/
DD
/
YYYY
Do you have any of the following symptoms: fever/feverish, chills, sore throat, dry cough, difficulty breathing, or digestive symptoms such as diarrhea, nausea, vomiting, and abdominal pain? *
In the past 14 days, have you been within 6 feet for 15 minutes with a person diagnosed with COVID-19? *
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Clarkston.k12.mi.us. Report Abuse