Highlands Staff Health Check
Please review the questions below and submit this form each day before you enter the campus. You may only enter campus if your answer is NO to all questions below. If your answer is YES to any question, remain off-campus and contact Ryan via phone, text, or email.

1. Have you been in close contact* with anyone who has been diagnosed with COVID-19?
2. Have you been in close contact* with anyone who is experiencing symptoms of COVID-19, but is yet to be confirmed?
3. Are you living with or been in close contact* with anyone such as a family member who is experiencing symptoms or has been confirmed as positive for COVID-19?
4. Have you traveled outside of the continental United States within the past 14 days?

*Close Contact is defined as being within approximately 6 feet of a COVID-19 case for a prolonged period of time; close contact can occur while taking care for, living with, visiting, or sharing healthcare waiting area or a room with a COVID-19 case or having direct contact with infectious secretions of a COVID-19 case (being coughed on).
Todays Date: *
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DD
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Staff ID # *
Initials *
Are you experiencing any symptoms such as: fever, cough, shortness of breath, lack of taste or smell, and/or sudden gastrointestinal illness? *
Combined response to questions 1-4 above: *
Comments - Please explain any "yes" answers above.
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