COVID-19 HEALTH SCREEN ATTESTATION:
To be conducted daily before access to the St. Luke School campus
Your Name (Person coming to campus)
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
What is your role at St. Luke School?
*
Student
Employee
Visitor
SYMPTOMS OF COVID-19
Cough
Fever (above 100ºF) or chills (before taking any medication to reduce the fever)
Shortness of breath or difficulty breathing
Unusual Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
Do you have any of the SYMPTOMS OF COVID-19 above that are not attributable to another condition?
*
Yes
No
What is your temperature?
*
Below 100.4ºF
Above or Equal to 100ºF
Within the past 14 days, have you had close contact with anyone that you know who had COVID-19? Close contact is defined as being within 6 feet for more than 15 minutes with a person, or having direct contact with fluids from a person with COVID-19 (for example, being coughed or sneezed on), or the person lives in your household.
*
Yes
No
Have you traveled out of sate or internationally recently? Unvaccinated individuals who travel out of state must quarantine.
Yes
No
Have you had a positive COVID-19 test for active virus in the past 10 days?
*
Yes
No
Within the past 14 days, has a public health or medical professional told you to self-monitor, self-isolate, or self-quarantine because of concerns about COVID-19 infection?
*
Yes
No
Submit to Obtain Campus Pass
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