Conrad Public Schools/Pondera County Health Department COVID-19 Travel Screening
To prevent the spread of COVID-19 and reduce the potential risk of exposure to our staff and students, we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measures to protect our staff and students. Thank you.
Student Last Name *
Your answer
Student First Name *
Your answer
Contact Phone Number *
Your answer
In the past 14 days, where did you travel? *
Your answer
Departure Date: *
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DD
/
YYYY
Return Date: *
MM
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DD
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YYYY
If you traveled by plane, what airports were you in & on what dates? *
Your answer
Were you around anyone who was ill? (Specifically respiratory illness - fever, cough, shortness of breath) *
Have you shown any signs or symptoms of illness? (fever, cough, shortness of breath) *
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