OACSD Visitor Daily Pre-Screening Form
By answering the questions below, I acknowledge that I have self-screened prior to coming onto the OA Campus and have not misrepresented my health in any way to the Owego Apalachin Central School District. I further understand that if the answer is YES to any of the questions above, I am NOT ALLOWED on school grounds and need to contact my health care provider immediately.
Email address *
First Name *
Last Name *
Department/Building I am Visiting *
Have you knowingly been in close or proximate contact in the past 14 days with anyone who has tested positive through a diagnostic test for COVID-19? *
Have you tested positive through a diagnostic test for COVID-19 in the past 14 days? *
Have you experienced any symptoms of COVID-19, including being extremely tired, dry cough, shortness of breath, loss of sense of smell or taste, nausea, vomiting, or diarrhea? *
Have you experienced a temperature of greater than 100.0°F in the past 14 days? *
Have you traveled internationally or from a state with widespread community transmission of COVID-19 per the New York State Travel Advisory in the past 14 days? *
A copy of your responses will be emailed to the address you provided.
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