BHASED COVID-19 Screening Form for Employees
The Illinois State Department of Public Health recommends that all employers put COVD-19 protocols in place to help prevent the spread of COVID-19 in there facilities by screening visitors and employees on a daily basis. The following screening protocol has been developed to align with the Illinois Department of Public Health.

Until further notice, the following groups must be screened daily:
- All employees at the start of each shift; and
- All visitors who are entering district facilities.
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Email *
1. Are you a staff member or guest? *
2. Please enter your first and last name. *
3. In which building are you starting your day (select one)? *
4. Since your last day of work (in person or remote), or visit to a BHASED building, have you had a cough that cannot be attributed to another health condition? *
5. Since your last day of work (in person or remote), or visit to a BHASED building, have you had shortness of breath that cannot be attributed to another health condition? *
6. Since your last day of work (in person or remote), or visit to a BHASED building, have you had a fever (100.4F or higher) that cannot be attributed to another health condition? *
7. Since your last day of work (in person or remote), or visit to a BHASED building, have you taken medication for a fever? *
8. Since your last day of work (in person or remote), or visit to a BHASED building, have you had any of the following symptoms that cannot be attributed to another health condition: chills, muscle or body aches, headache, sore throat, new loss of taste or smell, congestion and/or runny nose? *
9. Within the last 14 days have you been in close contact (within 6 feet for a cumulative total of 15 minutes or more over a 24-hour period) with anyone with a confirmed or suspected case of COVID-19? "Suspected" means that the staff member was in consistent close contact with a person who is displaying symptoms and is awaiting the results of a COVID-19 test. *
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