Coronavirus Disease (COVID-19)Workplace Health Screening for Hillsdale County ISD Staff
Please complete this form prior to entrance into an HCISD building. This form must be completed each day you are planning to be in an HCISD building. Please complete that day DO NOT complete the night before.
Date you are actually in the building
Time you are accessing the building
Are you currently experiencing any of the following symptoms: Please check all appropriate boxes
Fever or chills
Shortness of breath or difficulty breathing
Muscle or body aches
New loss of taste or smell
Congestion or runny nose
Nausea or vomiting
I confirm that I have not experienced any of the above symptoms.
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This form was created inside of JCISD.