COVID-19 Daily Screening Form
This form is to be completed the first day of your work week, each week, before entering any of the Avon Central School District buildings.

It is required that you self-administer a temperature check prior to coming to work each day. If you have a temperature of 100 degrees F or greater or symptoms associated with Covid-19, please do not report to work and contact your building health office.

Please remember to wear a mask in the hallway, common areas, and when closer than 6ft. Wash hands frequently and practice social distancing.

Please review the statement below and agree to the attestation.

Any individual making a false, or deceptive attestation, or violating these rules may be subject to disciplinary action up to and including suspension, or termination.
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Avon Email *
By signing the form below, you are attesting that you will take your temperature each day before work and will not report to work if you have a temperature of 100.0º F or higher. You are also attesting that you will not report to work if you exhibit any of the common symptoms associated with COVID-19 identified by the Department of Health and CDC following completion of this form. Additionally you are attesting that should you develop symptoms while at work, that you will follow the District’s protocols for notification to the administration.
I have reviewed the information above and agree *
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