SUHSD BVH Employee Self Screening Form
Before coming to campus, please self-assess and DO NOT come to campus if you or
someone you have come in contact with has tested positive for COVID-19, is awaiting
results on a COVID-19 test, or if you are experiencing any of these symptoms:
a. Fever or chills
b. Cough
c. Shortness of breath or difficulty breathing
d. Fatigue
e. Muscle or body aches
f. Headache
g. New loss of taste or smell
h. Sore throat
i. Congestion or runny nose
j. Nausea or vomiting
k. Diarrhea

While on campus, please follow all safety measures below:
1. Follow social distancing guideline of 6ft apart.
2. Wear a face mask.
3. Regularly wash hands during the day.
4. Face to face contact with other people on campus must be less than 10 minutes.
Last Name *
First Name *
BVHS Department *
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