Lake Forest South Elementary School Staff and Visitor Screening Questionnaire
To protect the public against the spread of COVID-19, Governor John Carney and Delaware Division of Public Health are REQUIRING that schools screen employees and visitors each day when they enter the building using the following questionnaire:

Please remember to continue following preventative measures while in the building:
- Wear a Mask
- Social Distancing
- Go Home When Sick
- Use Cough and Sneeze Etiquette
- Practice Hand Hygiene As Often and Thorough As Possible
- Clean High-Touch Surfaces In Your Area Regularly
Name: *
1. In the past 10 days, have you been near (within 6 feet for at least 15 minutes) a person who has a lab-confirmed case of COVID-19, or have you had direct contact with their mucus or saliva? *
2. In the last 48 hours, have you had any of the following symptoms?
Fever of 100.4 F or above (or symptoms like alternating shivering and sweating) *
New cough *
New trouble breathing, shortness of breath or severe wheezing *
New chills or shaking with chills *
New muscle aches *
Sore throat *
Vomiting or diarrhea *
New loss of smell or taste, or a change in taste *
Nausea *
Fatigue *
Headache, congestion or runny nose with no other known cause (such as allergies) *
3. If you answered 'Yes' to any of the symptoms above, do they have a known cause (i.e. asthma, COPD, sinusitis, allergies, etc.)? *
If you answered "Yes" to either question one or two and the symptoms do not have a known cause as identified in question three, you need to NOT report to work today or enter the building, and contact your doctor. Please notify you supervisor immediately and keep him/her informed of your progress while self-isolating and prior to determining a date for return to work.
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