COVID-19 Mandated Daily Screening
Per guidance from the Governor's Office regarding Phase re-openings, mandatory daily health screening assessments are required to be completed daily by anyone entering a school facility. Please answer the following questions.
* Required
Department
*
District Office
Transportation
Building and Grounds
IT
Food Service
Elementary School
JR High School
SR High School
Pupil Personnel Services
Instruction & Staff Development
Full name
*
Your answer
Have you knowingly been in close or proximate contact in the past 14 days with anyone who has tested positive for COVID-19?
*
Yes
No
Have you knowingly been in close or proximate contact in the past 14 days with anyone who has or had symptoms of COVID-19?
*
Yes
No
Have you tested positive for COVID-19 in the last 14 days?
*
Yes
No
Have you traveled internationally or out of New York State in the past 14 days? (excluding MA and CT)
*
Yes
No
Have you experienced any of the following symptoms in the past 48 hours? (Check all that apply)
*
Fever - >100 degrees Fahrenheit
Loss of smell
Vomiting
Shortness of Breath
Loss of taste
Diarrhea
None of the above
Required
Daily Temperature Check (<100 degrees Fahrenheit = pass)
*
Pass
Fail
If a Visitor/Contractor, please put company name if applicable
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Taconic Hills Central School District.
Report Abuse
Forms
