COVID-19 Daily Facility Entry Questionnaire
Hamilton County Schools (HCS) is committed to continue to serve our students, parents, and community during the COVID-19 pandemic.

To ensure the safety of our employees and community and in following the protocols of TN Pledge, CDC and Hamilton County Health Department, each HCS employees needs to attest to their wellness to enter facilities. By completing this questionnaire, you are attesting that as of the time and date of your visit to the facility, you are not experiencing any symptoms associated with COVID-19 (Novel Corona-virus) and have not experienced any of these symptoms during the 14-day period preceding your visit and that you have no knowledge or belief that you have been exposed to anyone with a confirmed case of COVID-19 during the 14-day period preceding your visit.

Please read and complete the below questionnaire each day prior to entry into any HCS facility. If you answer YES to any of the below questions, please do not enter the building and contact Human Resources immediately at 423-498-7048 or humanresources@hcde.org.

HR and School Health will maintain these records confidentially.

If you answer, YES, to any of the below questions... do NOT report to work!
Email address *
Employee Name *
School / Location *
Supervisor *
Have you been in close contact with a confirmed case of COVID-19 within the last 14 days? *
Are you experiencing a cough, shortness of breath or sore throat? *
Have you had a fever in the last 48 hours? *
Have you had new loss of taste or smell? *
Have you had vomiting or diarrhea in the last 24 hours? *
Best Personal Contact Phone Number
ATTENTION!!!!
If you answered, YES, to ANY of the above questions, do NOT report to work until you are cleared by School Health. Please also complete the Employee Self-Reporting form: https://forms.gle/RurhPsq23QwxXaJM9
A copy of your responses will be emailed to the address you provided.
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