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NNHS Daily Health Screening Form
Please complete this form upon entry into the building each morning
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* Indicates required question
For NPS Employees please enter your 5-digit EID Number. For visitors please enter First and Last Name
*
Your answer
Temperature: If 100.4F and higher you Do Not Meet Criteria to Enter the Building (please exit and contact your supervisor)
*
Your answer
Currently, or in the last 24 hours have you experienced a Cough, Sore Throat, Shortness of Breath, New Loss of Smell or Taste, Chills, or Muscle Pain/Body Aches?
*
Yes
No
Do you have any of the following Exclusionary Criteria?
Yes, Close contact with and/or Direct personal care for an individual positive for COVID19
Yes, Currently positive for COVID19
None of the above
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If you answer "Yes" to any of the above, you Do Not Meet Criteria to Enter the Building. Please exit the building and contact your principal or supervisor. If you have concerns or questions related to this screening please enter below and a nurse will contact you. Thank you and be well...
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