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 ANY OF 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. Do you/your child currently have (or have had in the last 10 days) one or more of these new or worsening symptoms?
    • Feel feverish or have chills
    • Cough
    • Shortness of breath or difficulty breathing
    • Fatigue or feeling of tiredness
    • Muscle or body aches
    • Headaches
    • New loss of taste or smell
    • Sore throat
    • Nasal congestion or runny nose
    • Nausea or vomiting
    • Diarrhea
    Note: Answer “yes” if the symptoms you/your child have experienced in the last 10 days are of greater intensity or frequency than what you/your child normally experience.
  2. Have you/your child had a fever (greater than or equal to 100.0°F) today OR within the last 10 days?

  3. Have you/your child tested positive for COVID-19 within the last 10 days OR are you/your child waiting for a COVID-19 test result?
  4. Have you/your child been designated a contact of a person who tested positive for COVID-19 by a local health department within the last 14 days?

  5. Have you/your child had close contact with a confirmed or suspected case of COVID-19 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.