Attestation of Health Status Related to COVID-19
Prior to accessing Harrold ISD facilities, all employees and guests are requested to complete an Attestation of Health Status (adapted from Governor Abbott’s Open Texas guidance document and CDC guidelines) regarding COVID-19 symptoms and level of contact with others exhibiting symptoms.
• A separate form is required for each individual entering the Harrold ISD facility for EACH DAY access is requested
• The form must be completed prior to building entry and not more than 18 hours in advance (If any conditions change prior to building entry but after the form is submitted, please resubmit)
• If an individual checks YES to the health question below, access to the Harrold ISD facility is temporarily denied, and the individual should contact Harrold for alternative methods to conduct tasks, to establish a timeline for reconsideration for entry, etc.

Symptoms/Conditions:
• Cough
• Shortness of breath or difficulty breathing
• Chills
• Repeated shaking with chills
• Muscle pain
• Headache
• Sore throat
• Loss of taste or smell
• Diarrhea
• Feeling feverish or a measured temperature greater than or equal to 100.0 degrees Fahrenheit
• Known close contact with a person who is lab confirmed to have COVID-19 or is undergoing testing for a suspected diagnosis of COVID-19 within the past 14 days
• I have either been diagnosed with COVID-19, been suspected to have the virus, or have been treating COVID-19 type symptoms at home, and all of the following conditions have not been met yet:
• At least 3 days (72 hours) have passed since recovery (resolution of fever without the use of fever-reducing medications)
• Improvement in respiratory symptoms (ie.. cough, shortness of breath)
• At least 10 days have passed since symptoms first appeared

First Name *
Last Name *
I am currently experiencing one or more of the symptoms/conditions listed above. *
I attest that this information is accurate to the best of my knowledge. *
Required
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