Brandon School District Daily Health Check In
Updated 1/19/2021
Email *
Last Name *
First Name *
What building are you assigned to mainly? *
1. Are you currently experiencing ONE or more of the following symptoms unrelated to a known pre-existing condition (e.g. asthma, allergies)?
If you are experiencing one or more of the above symptoms, stay home, consult your immediate supervisor and medical provider, and get tested for COVID-19.
2. Are you currently experiencing any TWO of the following symptoms unrelated to a known pre-existing condition (e.g. asthma, allergies)?
If you are experiencing two or more of the above symptoms, stay home, consult your immediate supervisor and medical provider, and get tested for COVID-19.
If you are experiencing one of these symptoms, stay home, consult your immediate supervisor and medical provider. You may return to work after being fever free for 24 hours without taking fever reducing medication and symptoms have improved.
3. Have you had close contact (within 6ft for 15 minutes or greater) with anyone (including household members) who had a positive COVID-19 diagnostic test in the past 14 days?
Clear selection
If yes to question 3, the CDC requires a 14 day quarantine from the last date of exposure.
All household contacts are excluded from work/school while results are pending. If test results are positive or if a symptomatic person does not get tested, household contacts are to quarantine for 14 days from last known exposure
If you answer NO to all the above questions, you have passed the screening and can report to work.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Brandon School District. Report Abuse