Daily COVID Screening
This form needs to be filled out prior to entry into the building each day. Your honest answers help keep each other safe and our school open. Thank you!
Name of person entering ASB
*
First Name
Last Name
Class
*
ASB Employee
PreK-A
PreK-B
KA
KB
1A
1B
2A
2B
3A
3B
4A
4B
5A
5B
6A
6B
7A
7B
8A
8B
Please read through this list. If no symptoms are present, you may check "NO". If any symptoms are present, please contact your healthcare provider, notify our main office and remain home until you have been advised that you may return. Has this person recently been exposed to COVID-19? Does this person have chills, a sore throat, a new or unusual cough, muscle aches, shortness of breath or diarrhea? Do they have a headache that is not not related to prior condition? Take their temperature: Is it 100 or above?
*
Yes
No
I hereby state that I have accurately answered these questions accurately.
*
Email
example@example.com
Submit
Should be Empty: