Notre Dame Visitor COVID-19 Daily Health Screening
Please fill out this form the morning of your visit.


1. You currently don't have any of the following symptoms:
     - Coughing or sore throat
     - Sneezing or runny nose (new or unexplained)
     - Shortness of breath or difficulty breathing
     - Fever (within the last 24 hours)
     - Fatigue (new or unexplained)
     - Chills, body aches, or muscle pain (new or unexplained)
     - Headache (new or unexplained)
     - Diarrhea, nausea, or vomiting
     - A sudden loss of taste or smell that is not related to allergies.  

2. In the last 10 days, you have not had close contact (within 6 feet for more than 15 minutes) with anyone you know tested positive for COVID-19 or has any of the symptoms listed above.

3. You will wear personal protective equipment, including a mask, while on campus and around others.

4. You will follow all social distancing and safety protocols posted on campus.

5. No one in your household has tested positive for COVID 19 in the last 10 days.

6. Your temperature is below 100.4 degrees and you haven’t taken any medication that could reduce your temperature.

7. All visitors are required to show proof of vaccination from COVID-19. A photo of a valid vaccine card or California SMART Health Card QR code serve as valid proof of vaccination.
Sign in to Google to save your progress. Learn more
Email *
Please check this box if you acknowledge that you meet all the criteria above. If you do not meet the criteria, you can not come to campus. *
Required
First Name *
Last Name *
Cell Phone Number *
ND Employee Hosting Your Visit *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Notre Dame High School. Report Abuse