Visitor Health Screening Questionnaire
The safety of our pupils, colleagues and visitors is our priority. As the COVID-19 outbreak continues to evolve, Edinburg Common School is monitoring the situation closely and will update its advice based on recommendations from the New York State Department of Health, Saratoga County Department of Health and New York State School Department of Education.

To minimize the spread of COVID-19 and to reduce the potential risk of exposure to our pupils and colleagues, we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measures to protect you and everyone on the campus. Thank you for your understanding.
Visitor First Name: *
Visitor Last Name *
Phone Number: *
Email Address: *
Company Name/Organization *
Self Declaration by Visitor
Have you tested positive for COVID-19 in the past 14 days? *
Have you had close contact with a person diagnosed with COVID-19, under investigation for COVID-19, or ill with a respiratory illness in the past 14 days? *
Have you experienced any of the following symptoms in the last 14 days? Symptoms of COVID-19 may include these symptoms but are not limited to (refer to CDC for the most recent information): Cough, Shortness of breath or difficulty breathing, Fever or feeling feverish, Chills, Fatigue, Muscle pain, Sore throat, New loss of taste or smell? Also less common symptoms including gastrointestinal symptoms like Nausea, Vomiting and Diarrhea. *
If you answered yes , have you provided documentation from your physician stating you may return to work?
Clear selection
Have you traveled outside the country in the last 14 days? *
If Yes, where did you travel? please include any layovers you had.
Have you been in close contact with anyone who has traveled to any countries within the past 14 days? *
If yes, which countries? Please include any layovers they might have had during their travel.
Temperature was taken and above 100.4 degrees *
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