Online Health Self-Assessment Form
The Croton-Harmon School District asks that this form be completed and submitted by every staff member each day before reporting to work.
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Your location you report to at the beginning of the day
In the last 48 hours have you had any of the following?
Fever (100 degrees or higher)
Shortness of breath or difficulty breathing
Muscle or body aches
New loss of taste or smell
Congestion or runny nose
Nausea or vomiting
None of the above
Did you check any of the above boxes that lists a symptom, AND is the symptom unrelated to a pre-existing condition?
If yes, please call your supervisor prior to reporting to work
Have you been exposed to Covid-19 in the last 24 hours?
In the last 14 days, did you care for or have close contact with someone diagnosed with COVID-19?
Have you traveled out of the country in the last 14 days, or have you experienced any symptoms since your return from traveling out-of-state?
Did you say, "Yes" to any of the three questions above?
If so, please contact your healthcare provider prior to reporting to work
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This form was created inside of Croton Harmon School District.