Faculty & Staff Daily Check In
This form must be filled out daily and ahead of time for each day you work at St. Mary's Elementary School. This is now part of your daily work responsibility.
Today's Date *
MM
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DD
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YYYY
Your name *
Best phone number to reach you this morning *
Do you have a temperature greater than 100°F? *
Required
Do you feel well today? *
Have you come in close, regular contact (within 6 feet) of someone who has a laboratory confirmed COVID-19 diagnosis within the past 14 days? *
Do you have any of the following: fever or chills, cough, shortness of breath or difficulty breathing, body aches, headache, new loss of taste or smell, sore throat? *
Have you traveled to any of the states on currently on the Advisory List in the last 14 days? *
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This form was created inside of Diocese of Rockville Centre. Report Abuse