Dawson ISD COVID-19 Pre-Screen
Please fill this form out before each work day.
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Name: *
Today's Date: *
Have you experienced any of the following symptoms that indicate a possible COVID-19 infection?
o Temperature of 100.4 degrees Fahrenheit or higher when taken by mouth;
o Sore throat that is not normal for you.
o New uncontrolled cough that causes difficulty breathing
o Diarrhea, vomiting, or abdominal pain that is not typical for you, or
o New onset of severe headache, especially with a fever

Please answer YES or NO to the above question: *
Have you had close contact with any individual who is lab-confirmed with COVID-19 in the last 14 days?
Close contact is defined as:
o Being directly exposed to infectious secretions (e.g., being coughed on); or
o Being within 6 feet for a cumulative duration of 15 minutes, and neither wearing a mask
If either occurred at any time in the last 14 days at the same time the infected individual was infectious.

Please answer YES or NO to the above question: *
If you answered YES to either question, submit this form, contact District Administration, and do not come to work until cleared to do so.
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