OHS HUB and Period Health Screening Form
In order to attend a pre-arranged HUB session with a teacher, all students coming on to campus must fill out this form each day they plan on attending a HUB session. Forms should be submitted BEFORE you come on campus for your appointment. If you have not submitted the form you will not be allowed on campus to meet for that day and will be sent home.
HUB Time is from 1:45-2:45 Tues, Wed, Thurs, and Fri. ALL students must have prior approval by their teacher to attend and space is limited for each session.
Starting Sept 28th students may be invited by their teacher to be in one or more classes during the school day. Teachers will need to invite students to campus as some teachers are still teaching remotely. Students attending more than one class will need an invite from each individual teacher. If a student has a class period in between invited periods or lunch there will be an open common area for them to log in to their DL class or eat their lunch.
Students need to fill out this form before coming on to campus the day they are coming in.
You will automatically receive a response receipt email for this form each day that you submit. Please be prepared to show proof of completion at the front office for check in. Always bring your student ID card when coming to campus and be prepared to show it to any OHS Staff member.
Please note that a YES answer to any of the screening questions means a student should not attend the HUB or attend classes. Any student checking YES to any of the screening questions will be contacted by our school nurse.
Date You are Attending a class period or HUB (Please use the calendar icon to select your date)
When are You are Attending (mark all that apply)
Period 1 8:00-9:00 am
Period 2 9:15-10:15 am
Period 3 10:30-11:30 am
Period 4 12:30-1:30 pm
HUB 1:45-2:45 pm
Person's LAST NAME who is attending
Person's FIRST NAME who is attending
Staff Member Name with whom the student has an appointment. Please list all appointments
Within the last 14 days, have you been diagnosed with COVID-19 by a medical professional or had a test confirming you have the virus?
In the last three (3) days, have you had or developed one or more of these symptoms: fever of 100˚F or greater, fatigue, body aches, chills, night sweats, cough, congestion, runny nose, shortness of breath, sore throat, headache, nausea or vomiting, diarrhea, a new loss of taste or smell?
Have you been in close contact (within six (6) feet for 15 or more minutes) in the last 14 days with a confirmed positive COVID-19 person?
A copy of your responses will be emailed to the address you provided.
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