Staff COVID-19 Symptom Tracker
If you have symptoms of illness, please complete this tracker to assist your supervisor and HR
First and Last name of staff person completing this form.
Phone number of the person completing this form.
Have you been vaccinated?
Yes, it has been more than 14 days since my last shot.
Yes, but my vaccination series is not complete OR my second shot was less than 14 days ago.
Who is the employee's supervisor
Date of Onset
Time of onset
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This form was created inside of Klamath Falls City Schools.