SCCSD COVID Entry Form
Please complete this form each day when you arrive into a District building.
Employee Name: *
Todays Date *
MM
/
DD
Assigned Building/Location *
Do you have a fever over 100°? *
Since you were last here, have you had any of the following symptoms? *
Please check all that apply
Required
Have you traveled outside New York State or USA within the last 14 days *
If you have no traveled to a restricted state, please check the top box, if you have and the trip was LESS than 24 hours, you are not obligated to report the destination. If the trip was MORE than 24 hours, please list the destination under Other.
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