COVID 19 screening form - Hopatcong Schools
By entering any school buildings within the Hopatcong Borough School District you affirm the following (as a staff member or on behalf of your child(ren) attending school):

a) You (or the student) have not in the last 14 days had any close contact with anyone who is either confirmed or suspected of being infected with COVID-19, including anyone who was experiencing or displaying any of the known symptoms of COVID-19 (listed below); AND

b) You (or the student) do not currently experience or display, and you have not in the last 10 days experienced or displayed, any of the following symptoms:

- elevated temperature or fever of 100.4 or higher
- cough
- chills or shaking
- shortness of breath and/or difficulty breathing
- loss of smell and/or taste
- fatigue/muscle aches
- persistent headaches
- nausea or vomiting
- diarrhea
- sore throat
- congestion/runny nose

c) You (or the student) have not traveled out of the country in the last 10 days.
Sign in to Google to save your progress. Learn more
Your Name (Last Name, First Name)/ Names of your student children (Last Name, First Name) *
Your school (where you work or your children attend) - Check all that apply *
After reading the message above I (my children) are approved to attend work/school*. (*PLEASE NOTE THAT IF YOU CANNOT ANSWER "YES" YOU SHOULD NOT COME TO SCHOOL AND YOU SHOULD CONTACT THE SCHOOL NURSE) *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Hopatcong Borough Schools. Report Abuse