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.
Building and Grounds
JR High School
SR High School
Pupil Personnel Services
Instruction & Staff Development
Have you knowingly been in close or proximate contact in the past 14 days with anyone who has tested positive for COVID-19?
Have you knowingly been in close or proximate contact in the past 14 days with anyone who has or had symptoms of COVID-19?
Have you tested positive for COVID-19 in the last 14 days?
Have you traveled internationally or out of New York State in the past 14 days?
If YES above, please tell us State or Country you traveled to.
Have you experienced any of the following symptoms in the past 48 hours? (Check all that apply)
Fever - >100 degrees Fahrenheit
Loss of smell
Shortness of Breath
Loss of taste
None of the above
Daily Temperature Check (<100 degrees Fahrenheit = pass)
If a Visitor/Contractor, please put company name if applicable
Never submit passwords through Google Forms.
This form was created inside of Taconic Hills Central School District.