Coronavirus Disease (COVID-19)Workplace Health Screening for Hillsdale County ISD Visitor
Please complete this form upon entering an HCISD building.
Visitor's Name
Today's Date
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DD
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Time In
Time
:
Current Temperature - If your temperature is 100.4 or greater please go or stay home and contact your Primary Care Provider. *
In the past 24 hours, if have you experienced any of the symptoms below please check the box next to the symptom that you have experienced. If you have not had symptoms please check the last box. *
Required
In the last 14 days have you; please check the appropriate boxes below *
Required
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