Wellness Check-In Survey
Due to COVID-19, please fill out the following form, prior to entering the building, for the safety of our students, staff and others.
First and Last Name: *
Phone Number: *
Today's Date: *
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Do you have a fever or have you felt hot or feverish recently (14-21 days)? *
Are you having shortness of breath or other difficulties breathing? *
Do you have a cough? *
Are you in contact with any confirmed COVID-19 positive person? *
Have you traveled in the past 14 days to any regions affected by COVID19? (as relevant to your location) *
**Positive responses to any of these would likely indicate a deeper discussion with an administrator before entering the building.
Do you have a clean face covering? *
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