Updated 2020-21 Daily Employee Health Screen Agreement
As an employee of Mequon Jewish Preschool, your health and safety are very important to all of us here. In an effort to prevent the spread of COVID-19, please complete and submit the below health screening questions each day before bringing your child to school.
.
Your Name *
I do not currently have, nor have had, a temperature over 100 degrees in the past 48 hours *
I do not currently have, nor have had, potential symptoms of COVID-19, such as shortness of breath or persistent dry cough in the past 48 hours *
I have not taken medications to lower my temperature. *
There is no one in our household who has COVID-19 *
By signing my name and date below, I acknowledge that all statements above are true. *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy