Infectious Disease Lab Screening
Screening Date
-
Month
-
Day
Year
Date
Screening Completed By(Name of Staff Member On Site):
First Name
Last Name
Student Name
First Name
Last Name
Skills Lab Site
Abilene, TX
Troy, MO
Temperature Reading
Does Student Have Any Of These Symptoms:
Cough
Fever of 100.4F or higher
Chills
Runny/Stuffy Nose
Shortness of Breathe
Sore Throat
Has student returned from international travel in the last 14 days?
Yes
No
Has student had exposure to someone with, or anyone with any infectious disease that could be easily spread in the skills lab environment?
Yes
No
Comments:
Cleared To Enter Site?
Yes
No
Submit
Should be Empty: