WOLCA STAFF Daily Screening
REMINDER: IF YOU HAVE TRAVELLED OUT OF STATE FOR OVER 24HOURS YOU MUST SHOW PROPER DOCUMENTATION (NEG COVID TESTS) PRIOR TO COMING IN TO WORK. This form is to be filled out daily for each staff member.
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STAFF Member's Name *
My temperature this morning is:
I attest am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell. *
I attest that I have not travelled out of the state of New York. If I have, I have followed the NEW NYS Guidance for traveling outside of the state and have provided the school with the appropriate documentation. *
I do not believe I or my family have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19. *
I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19. *
I or a member of my family have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities. *
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