Plato Learning Academy COVID-19 Screener
All employees, students, parents, and visitors to the school must complete this form before they are can enter the building.
General Information
Name *
Role *
Purpose of Visit *
Phone Number *
Email Address *
Screener Questions
In the last 24 hours have you experienced any of the following symptoms that you cannot attribute to another health condition? Please check all that apply. If yes to any, you must leave the building immediately and contact your physician. *
Required
Have you been in close contact with a person who has tested positive for COVID-19 in the past 14 days? If yes, you must leave immediately and quarantine for 14 days. *
Have you traveled outside of the state in the past 14 days? *
If so, what state(s) did you visit?
Have you traveled internationally in the past 14 days? *
If so, what country did you visit?
Have you tested positive for COVID-19 in the past 10 days? If yes, you must leave immediately to complete at least 10 days from your first symptom AND 24 hours since your last fever without the use of fever-reducing medications AND your other symptoms are improving *
Are you waiting on the results of a COVID-19 test? If yes, you must leave immediately to wait on your test results. *
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