Union County Career and Technical Institute (UCCTI) Daily Health Screening Questionnaire

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You are receiving this survey because you are a student at the Union County Career and Technical Institute (UCCTI). All students are required to complete a daily health questionnaire by 7:00 am each morning. You will not be permitted to enter any buildings at the Union County Vocational-Technical Schools until this survey has been completed each day. You will be asked to report your temperature in completing this survey. Additionally, your temperature may be taken prior to entering any buildings. You will receive an email receipt, please show email in order to gain access to the building.

Email *

What is today's date? *

YYYY

What is your last name? *

What is your first name? *

Please take your temperature and record the temperature in degrees Fahrenheit below. (If your temperature is more that 100.4 degrees F, please do not come to school. Notify your building administrator and the school nurse at 908-889-8288 ext. 405)

In the last 14 days, have you been in close contact (within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period) with a person with confirmed COVID-19? *

Yes

No, not to my knowledge

In the last 14 days, has someone in your household been diagnosed with COVID-19? *

Yes

In the last 14 days, have you traveled within the United States (defined as lasting 24 hours or longer to states or US territories other than those connected to New Jersey, such as Pennsylvania, New York and Delaware) or have you traveled internationally? *

I have not traveled outside of New Jersey, Pennsylvania, New York or Delaware in the last 14 days

I have traveled within the United States within the last 14 days

I have traveled internationally within the last 14 days

Are you experiencing any of the following symptoms? If you check yes to experiencing at least two of the following symptoms, you are required to: stay home, notify the school nurse and attendance office, and follow-up with a physician. *

Fever or chills

Fatigue

Muscle or body aches

Headache

Sore throat

Congestion or runny nose

Nausea or vomiting

I am not experiencing an of the above symptoms

Required

Are you experiencing any of the following symptoms? If you check yes to experiencing at least one of the following symptoms, you are required to: stay home, notify the school nurse and attendance office, and follow-up with a physician. *

Cough

Shortness of breath or difficulty breathing

New loss of taste or smell

I am not experiencing any of the above symptoms

Required

A copy of your responses will be emailed to the address you provided.

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