Bayou Meto COVID-19 Staff Self-Screening Form
Complete this form prior to entering. If your response to any question is "Yes", then notify your supervisor immediately.
Sign in to Google to save your progress. Learn more
Email *
Last Name *
First Name *
Location *
Have you experienced ANY of the following symptoms; Unexplained Cough; Unexplained Difficulty Breathing; Unexplained Shortness of Breath; Unexplained Sore Throat; Unexplained Loss of Taste or Smell? *
Have you had close contact with an infected person (COVID-19) within the previous 14 days? *
Have you experienced a fever of 100.4 within the last 48 hours? *
Temperature *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Jacksonville North Pulaski School District. Report Abuse