COVID-19 Mandated Visitor Screening Questionnaire

Per guidance from the Governor's Office regarding Phase 4 - re-openings, mandatory health screenings are required to be completed DAILY by any vendor or visitor entering a school facility. Please complete the following survey. If your response is "yes" to ANY of the first three questions below, DO NOT ENTER THE BUILDING until further notice, answers will be reviewed by the school nurse and district administration daily in order to ensure full compliance with the Governor's regulations.

*All fields are required

Name: _________________________________________________________

Reason for visit:

Today's Date (La fecha de hoy): ____________________________________________________

Regardless of vaccination status, it is essential you are looking out for symptoms including sore throat, nasal congestion or runny nose, fever (>100.4), cough, body aches, and fatigue. If any symptom(s) develop, please isolate immediately and seek testing.

Are you currently experiencing one or more of these symptoms?

Yes (SÍ)

Since the last weekly health screener, I have tested positive for COVID-19 and I have completed, or will complete, the Affirmation of Isolation.

Yes (SÍ)

Since the last weekly health screener, I have been notified that I may have been in close contact with a positive individual and I have completed the Affirmation Of Quarantine if appropriate.

Yes (SÍ)

I am aware that free, voluntary testing is available at the District Offices located at Millbrook Middle School from 6:45 a.m. to 8:45 a.m. on school days. To register for testing, please complete the registration form at the following link: TESTING REGISTRATION FORM

Yes (SÍ)

I certify to the best of my knowledge this information is accurate.

Campus Access

COVID-19 Mandated Visitor Screening Questionnaire

You are clear to enter the building!

Please remember to follow social distancing guidelines and keep a safe distance to slow the spread.

Based on your responses you are not eligible to enter the building.

COVID-19 Mandated Visitor Screening Questionnaire

You are clear to enter the building!Please remember to follow social distancing guidelines and keep a safe distance to slow the spread.

Based on your responses you are not eligible to enter the building.

You are clear to enter the building!

Please remember to follow social distancing guidelines and keep a safe distance to slow the spread.