Kahnawake Education Centre COVID-19 Daily Health Check.
Covid Self Reporting
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Email address
*
Your email
Date
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MM
/
DD
/
YYYY
name
*
Your answer
Have you been out of the country in the last 14 days?
*
Choose
no
yes
Is any member of the household currently awaiting a COVID-19 test result? If so you must stay home for the duration of isolation of the family member.
Choose
Yes
No
Have you been in contact with anyone who has tested positive for COVID 19 in the last 14 days?
*
Choose
No
Yes
Does your student or you (if staff) have any of the following symptoms
*
• Fever (>38C or >100.4F) / Chills
• New cough or worsening cough
• Difficulty breathing
• Sudden loss of smell or taste without nasal congestion
• New onset headache
• New onset pain (muscular, chest, abdomen, joints)
• New intense fatigue
• Sore throat
• Diarrhea or Vomiting
• NO SYMPTOMS
Required
Will you be working from the office today? If you have answered YES to either of the above questions or exhibit symptoms listed above DO NOT COME INTO THE OFFICE and follow the instructions provided below.
Choose
Yes
No
Do you have to stay home due to a family member or child showing symptoms/awaiting test results?
Choose
No
Yes
I acknowledge that I have read this, and understand that COVID_19 is highly contagious, and that if my child or me (if staff) has any of the above symptoms they will stay home and contact the KMHC Testing Center to determine if they need to be tested for COVID-19. Phone number of the testing site (450-638-3930 ext. 2296 or ext. 2275)) Let’s make school FUN, EDUCATIONAL and SAFE. I UNDERSTAND
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I agree the above is correct
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