LSUU Health Screening - Please Read Intro Section Below (updated 4/23/21)

For all LSUU families:

There have been several changes in response to the most recent directive from the Agency of Education

*** Parents are responsible for completing temperature checks and daily screenings at home each morning.

*** Greeters will be on buses and at school to assist families with this if needed.

*** Families are asked to pay attention to Vermont’s quarantine guidelines (

*** Siblings of any student(s) that have been deemed a close-contact (including individuals in the household) and/or ill, may attend school, unless they themself are also a close-contact or ill, per a directive from the Agency of Education.

*** All students and school personnel will be dismissed from in-person learning and sports activities, if they:

• Show symptoms of COVID-19 (see last question below)

• Have been deemed a close contact to someone that has COVID-19 (fully vaccinated individuals may attend in-person learning per VDH guidelines- no quarantine unless symptomatic).

• Have a fever (temperature greater than 100.4°F).

• Are currently in isolation due to testing positive for COVID-19 or directed by you healthcare provider and/or the VDH.

*** Contact Jordan Myerson: Director of Nursing Services/COVID-19 Coordinator - 802-585-4087- with any questions (email: ).

***By proceeding, you agree with the above statements ***
Name (First,Last) *
Select the School Building *
Did you remember to take your temperature? (Stay home if temperature greater than 100.4°F). *
In the past 24 hours, have you taken any medication to help reduce a FEVER only? Examples: Ibuprofen (Advil, Motrin), Acetaminophen (Tylenol), or OTC (Over-The-Counter) medication such as Cold/Flu multi-symptom relief *
In the past 2 weeks (14 days) have you been told to stay home and Isolate or Quarantine for COVID-19 purposes? *
Are you sick/presenting with symptoms- and/or not feeling well today? *
In the past 14 days (2 weeks) have you (1) tested positive for COVID-19, (2) been in close contact with someone who has COVID-19, and/or (3) been living with/providing direct care for someone who has COVID-19? *
Do you have any or have experienced any of the following symptoms in the past 14 days (2 weeks)? EXCEPTION: If a person is diagnosed by your physician with a chronic/seasonal illness with similar symptoms, but unrelated to COVID-19*** (call Jordan Myerson: 802-585-4087 or email with questions) *
If you are experiencing ANY symptoms and have checked boxes, the person will be restricted from entering the building. ***
Never submit passwords through Google Forms.
This form was created inside of Lamoille South Supervisory Union. Report Abuse