Required: Daily Attestation East Greenwich Public Schools (Vendors/Contractors With No EGSD Email Address)

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Please complete this form each day, PRIOR to entering the school building as required by the Rhode Island Department of Health

Email *

Last Name, First Name *

Phone number *

Company or Organization (if applicable)

School/Building (Check all that apply) *

EGHS

Cole

Eldredge

Hanaford

Frenchtown

Meadowbrook Farms

Town Hall

111 Peirce

Required

SYMPTOMS- HAVE YOU HAD ANY OF THE FOLLOWING SYMPTOMS IN THE PAST THREE DAYS THAT ARE NOT EXPLAINED BY ALLERGIES OR A NON-INFECTIOUS CAUSE? IF YES, PLEASE CHECK THE SYMPTOM(S).

COUGH

SHORTNESS OF BREATH OR DIFFICULTY BREATHING

FEVER OR CHILLS

MUSCLE OR BODY ACHES

SORE THROAT

HEADACHE

NAUSEA OR VOMITING

DIARRHEA

RUNNY NOSE OR STUFFY NOSE

FATIGUE

RECENT LOSS OF TASTE OR SMELL

RISK FACTORS- CHECK THE BOX IF YOU ANSWER "YES" TO ANY OF THE FOLLOWING RISK FACTORS.

Have you been in close contact (less than six feet) with anyone with COVID-19 or symptoms of COVID-19 in the past 14 days?

Have you traveled anywhere outside the 50 United States in the past 14 days?

Have you traveled to Rhode Island for a non-work-related purpose from another city, town, county, or state that currently has a stay-at-home restriction, a shelter-in-place restriction, or a similar restriction, declaration, or announcement due to a COVID-19 outbreak?

Have you been directed to quarantine or isolate by the Rhode Island Department of Health or a healthcare provider in the past 14 days? If so, when does/did your quarantine or isolation period end?

A copy of your responses will be emailed to the address you provided.

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