Band COVID-19 Screening Form
Fill out this form before each time you come to Band.
* Required
Email address
*
Your email
Full Name
*
LAST name, then FIRST name
Your answer
Have you recently began experiencing any of the following in a way that is not normal for you?
*
Feeling feverish or a measured temperature greater than or equal to 100.0 degrees Fahrenheit, loss of taste or smell, cough, difficulty breathing, shortness of breath, fatigue, headache, chills, sore throat, congestion or runny nose, shaking or exaggerated shivering, significant muscle pain or ache, diarrhea, nausea or vomiting.
Yes
No
Have you had known close contact with a person who is lab confirmed to have COVID-19 within the last 14 days?
*
Close contact is being directly exposed to infectious secretions; or being within 6 feet for a cumulative duration of 15 minutes; however, additional factors like case/contact masking (i.e., being consistently and properly masked), ventilation, presence of dividers, and case symptomology may affect this determination.
Yes
No
Is anyone in the household awaiting COVID-19 test results?
*
Students should not enter campuses or district buildings if anyone, including themselves, is awaiting COVID-19 test results.
Yes
No
A copy of your responses will be emailed to the address you provided.
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