HS 1327 Staff Daily Health Screener

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All staff (Certificated/Classified/Coaches/Volunteers) must complete this form prior to entering any school building.

Email *

First Name *

Last Name *

What is your role?

District Staff (Certificated/Classified/Confidential/Administrator)

Coach

Volunteer

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Are you experiencing any of the following symptoms? Persistent, unexplained cough ; Chills or fever measuring 100.4℉ or above ; Shortness of breath or difficulty breathing ; Unexplained or unusual headache, ; Diarrhea ; Nausea or vomiting ; Congestion or runny nose ; Sore throat *

YES - I am experiencing at least one of the following symptoms.

NO - I am not experiencing any of the following symptoms

Have you been exposed to a COVID-19 POSITIVE person? [Spent 15 mins or more within 6 feet (with or without a mask) or live in the same household as someone who tested positive for COVID-19 within the last 14 days]

Yes

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