SCREENING QUESTIONS

  • Please know that the following questions are intended to limit any exposure to COVID-19 for you and the CCSD students and staff.  All responses are confidential and we appreciate your cooperation. 

    CCSD Staff members are required to complete this survey every day they are at work, no later than one hour prior to the start of your workday.  Parents/ Guardians are rewquired to complete this survey before sending their child to school.   

    Temperature Check

    • Is your temperature today 100 degrees (F) or Higher        (  ) Yes (  ) No  

     

    Health Screening Questions

    • Since the last day of work, have you had any of these symptoms?: temperature 100 degrees (F) or higher, cough, shortness of breath, difficulty breathing, chills, muscle pain, headache, sore throat, new loss of taste or smell, vomiting or diarrhea.  Note: Answer “yes” if the symptoms you have experienced are new and not related to any chronic condition.  

    (  ) Yes (  ) No 

    • Have you had a positive COVID-19 test in the past 14 days?

    (  ) Yes (  ) No 

    • Have you had close contact with a confirmed or suspected COVID-19 case in the past 14 days?

    (  ) Yes (  ) No 

    (  ) Yes (  ) No