COVID-19 Screening Declaration - Visitors
This health screening questionnaire is offered for informational purposes to help you check for COVID-19 symptoms as outlined by the Centers for Disease Control. The guidance you receive depends on the accuracy of the information you provide as well as current guidelines for identifying symptoms associated with COVID-19. Please take the survey and provide the response to the school district. This is not a substitute for professional medical advice, diagnosis, or treatment of disease or other conditions, including COVID-19. Always consult a medical professional for serious symptoms or emergencies.

Your health and well-being are of the upmost importance and we are taking measures to keep the facility/office a safe environment for our students as well as the individuals under our charge and the public. Therefore, anyone coming into the building may be screened and part of our screening process may include taking your temperature and asking the following questions.

Please complete this health screening questionnaire prior to entering any district facility. All visitors are required to wear face coverings in hallways, offices, restrooms and other confined spaces.

Thank you in advance for partnering with us to promote a safe environment for all members of the West Babylon School District community.
Email *
First Name *
Last Name *
Location/building *
Required
Temperature checks are required to be completed before entering our facilities. Do you have a temperature of 100.0 F or higher? *
Have you had COVID-19 symptoms in the past 10 days? (The current CDC definition of symptoms includes: fever, cough, shortness of breath, or at least two of the following symptoms: fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell)* *
Have you had a positive COVID-19 test in the past 10 days or are awaiting results of a COVID-19 test? *
Have you had close contact with confirmed or suspected COVID-19 cases in the past 10 days? *
By checking this box I am confirming the above information is accurate. *
Required
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