COVID-19 Daily Mandatory Health Check

COVID-19 Daily Mandatory Health Check

For the duration of the COVID-19 pandemic, students, staff, contract workers, volunteers and the general public are each responsible for monitoring yourselves and your immediate household each day for COVID-19 symptoms. You are required to check-in with the Arbutus Folk School (AFS) administrator at info@arbutusfolkschool.org EVERY DAY YOU COME IN BEFORE ARRIVING to affirm that you are not experiencing any of the symptoms listed below.
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Name of Class *
Start Time of Class *

: Hour Minutes AM/PM Option
Location of Class or Activity *

Ceramics Studio Arbutus Woodshop Front Classroom Olympia Woodturners (Larry's Shop) Blacksmith Studio (Kelly's Shop) Office Unsure
I am a.... *

Student Instructor Employee Public Volunteer
Mark each box if the answer is NO *

Do I have a fever (100.4 or higher), or a sense of having a fever? Have I lost my sense of taste or smell? Do I have a new cough that I cannot attribute to another health condition? Do I have a new shortness of breath that I cannot attribute to anotherhealth condition? Do I have a new sore throat that I cannot attribute to another healthcondition? Do I have new muscle aches (myalgia) that I cannot attribute to another health condition? Have you tested positive for COVID-19 within the last 14 days? As far as you are aware, have you been in contact with anyone who ispositive for COVID-19 within the last 14 days? Have you left the state in the last 14 days?
If the answer to any of the questions above is YES whether you are a student, staff, contract workers, volunteer or the general public, immediately inform Arbutus admin (email info@arbutusfolkschool.org), stay home, and consult your health provider.

If the answer is no to all of these questions, you may come to class. Please:
- Select "I agree" below
- Bring a mask or face covering to wear during all class times and anytime you are in a shared workspace with other AFS staff, contract workers, and/or students.
I agree that the information I have provided in this form is accurate. *

I agree
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