DBHS Daily Health Screening Log

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All persons are required to complete a health screening, prior to entry to any WVUSD property, by answering the questions below. This Screening is vital to ensure the health and well-being of each person on our WVUSD sites. No person will be allowed to enter a WVUSD worksite if they answer YES to any of the health screening questions.

**CLOSE CONTACT is defined as: Being within approximately 6 feet of a COVID-19 case for 15 minutes or more; close contact can also occur when having direct contact with infectious secretions of a COVID-19 case (being coughed on).

Please indicate the category that best describes you: *

WVUSD Staff Member

DBHS Student

Parent of a DBHS Student

Other Visitor

First Name *

Last Name *

Location On Campus You Are Visiting: *

1. Have you recently experienced, or are experiencing, symptoms such as a fever (100.4° or higher), chills, cough, shortness of breath or respiratory illness, sudden lack of taste or smell, or sudden onset of unexplained gastrointestinal illness? *

Yes

2. Have you been in close contact** with a person known to be infected or suspected to have COVID-19 within the last 10 days and you are unvaccinated? *

Yes

***If you answered YES to any of the health screening questions above, please explain

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