COVID-19 Self Assessment
The health and safety of our students and staff is of the utmost importance to us. Please complete this mandatory checklist prior to reporting to work. If you answer "yes" to ANY question, you must remain home and are not permitted to enter any VVS building. If you are working or learning remotely today, you do not need to fill out this form.
* Required
First and Last Name:
*
Your answer
Building(s) you will be entering:
*
E.A. McAllister Elementary
J.D. George Elementary
W.A. Wettel Elementary
Middle School
High School
Central Office/Bus Garage
Required
Have you experienced any symptoms of COVID-19, including a temperature of greater than 100.0° F in the past 14 days, (including today)?
*
Yes (If yes, for the health and safety of others, you may not report to work).
No
Have you knowingly been in close or proximate contact in the past 14 days with anyone who has tested positive through a diagnostic test for COVID-19 or who has had symptoms of COVID-19?
*
Yes (If yes, for the health and safety of others, you may not report to work unless you have been cleared by the local health department or the district.)
No
Have you traveled internationally or from a state with widespread community transmission of COVID-19 per the NYS Travel Advisory in the past 14 days?
*
Yes (If yes, for the health and safety of others, you may not report to work).
No
Have you tested positive through a diagnostic test for COVID-19 in the past 14 days?
*
Yes (If yes, for the health and safety of others, you may not report to work).
No
Submit
Never submit passwords through Google Forms.
This form was created inside of Vernon Verona Sherrill Central School District.
Report Abuse
Forms