COVID-19 Screening Attestation

The safety of the employees, students, families, and visitors remains our top priority. As the COVID-19 outbreak continues, we will closely monitor the situation and will periodically update our guidance based on current recommendations from New York State.

Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions (e.g. serious heart disease, chronic lung disease or asthma, immunocompromised, severe liver disease, etc.) might be at higher risk for severe illness from COVID-19. If you are concerned about underlying medical conditions, please consult with your personal medical health care provider.

To prevent the spread of COVID-19 and reduce the potential risk of exposure to our employees, students, families and visitors, we are conducting a simple screening. Your participation is important to help us take precautionary measures to protect you and everyone in our school district.

You are required to complete this screening everyday prior to entering a facility.

IF YOU ANSWER YES TO THE SCREENING QUESTIONS BELOW DO NOT ENTER THE BUILDING OR REPORT TO SCHOOL / WORK

Screening Questions

Please select a valid location.
Please select a valid sub-location.
Please select a valid sub-location.
Please select a valid sub-location.
Please select a valid sub-location.
Please select a valid role.

  1. Since your last day of work, school, or last visit here, have you had any of these symptoms?
    • Chills
    • Cough
    • Shortness of breath or difficulty breathing
    • Fatigue
    • Muscle or body aches
    • Headache
    • New loss of taste or smell
    • Sore throat
    • Congestion or runny nose
    • Nausea or vomiting
    • Diarrhea
    Note: Answer “yes” if the symptoms you have experienced in the last 14 days are of greater intensity or frequency than what you normally experience.
  2. Have you had a fever (greater than 100.0°F) today or within the last 14 days?

  3. Have you had a positive COVID-19 test within the last 14 days?
  4. Have you had close contact with a confirmed or suspected case of COVID-19 within the last 14 days?
  5. Have you traveled internationally or from a state with widespread community transmission of COVID-19 per the New York State Travel Advisory within the last 14 days?


Employees: I am doing my part to keep myself and others safe and I am following the practices outlined in our COVID-19 safety protocols.  If I experience symptoms while at work, I will immediately notify my supervisor and the school nurse.


Students and Guests: I am doing my part to keep myself and others safe and I am following the practices outlined in New York State's and the school district's safety protocols.  If I experience symptoms while at a school building, I will immediately notify my teacher or host.


Parent/Guardian: If filling out this form on behalf of a student, please provide the student's first and last name.
Valid first name is required.
Valid last name is required.
Please enter a valid email address for location access.
Please enter a valid phone number for location access.