ESASD COVID-19 Daily Self-Checklist
To further promote your personal safety and the well-being of those you may come in contact with through your employment, you are required to respond to the self-check questions below each day prior to reporting for work.
Thank you for your help in protecting your health and the health of those around you.
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Email *
First Name *
Last Name *
Current position in ESASD *
Reporting to (Location): *
Have you experienced any cold or flu-like symptoms in the last 14 days (to include fever, cough, sore throat, respiratory illness, difficulty breathing)? *
Have you, or anyone you have been in close contact with been diagnosed with COVID-19, or been placed in quarantine for possible contact with COVID-19 in the last 14 days? *
Have you been asked to self-isolate or quarantine by a medical professional or a local public health official in the last 14 days? *
Have you returned from international travel or have you been in close contact with anyone who has returned from international travel within the last 14 days? *
ACKNOWLEDGEMENT:  I acknowledge that If I answered YES to any of the questions above, I MUST STAY HOME, notify my immediate supervisor and contact  If during the course of my day, my conditions change for any of my initial responses, I am to immediately contact my supervisor. *
 I have received and read the CDC guidelines and recommendations as provided by the district. *
A copy of your responses will be emailed to the address you provided.
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