COVID-19 Staff Health Assessment
School and DOE employees who are working on site during the COVID-19 outbreak must perform a self- screening at home BEFORE reporting to work or school each day. This screening tool was adapted from the Mayo Clinic’s online COVID-19 Self-Assessment.

Please answer the following questions.
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Name *
Have you taken a COVID-19 Test in the past 7 days? *
Have you seen a positive result from a COVID-19 test in the past 7 days? *
If you answered YES to the question above, do NOT report to work or school. Instead, contact your supervisor and your doctor to get another test.
In the past 14 days, have you been near (within 6 feet for at least 15 minutes) a person who has a lab-confirmed case of COVID-19, or have you had direct contact with their mucus or saliva? *
In the last 48 hours, have you had any of the following symptoms? *
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If you answered YES to any of the questions above due to pre-existing conditions please contact your HR Director before the end of the day.
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