COVID-19 Employee Screening | Ferguson-Florissant School District

If any of these conditions exist, stay home! Notify your supervisor and do NOT come to work.

You are waiting for COVID-19 test results.
You have had two or more Low Risk symptoms listed below, or a single High Risk symptom listed below within the last 24 hours that cannot be explained by another health condition.

Contact your physician if you have 2 or more low risk symptoms or a single high risk symptom.

Your name

Employee ID

Role

I acknowledge that I have reviewed the above and will adhere to the following:

Complete a self-temperature check and obtain a result of less than 100°F.
Practice good hand hygiene by washing hands with soap and water for at least 20 seconds, especially after nose blowing, coughing or sneezing.
Avoid touching eyes, nose and mouth.
Wear a mask while in the building.
Always maintain at least six feet social distance while in the building.
Make the building supervisor aware if any of the low or high risk symptoms should occur after this screening has been submitted but prior to my arrival to their location.

Please select only one of the options below:

I affirm:

I affirm:

I am not currently exhibiting any COVID-19 symptoms.
I have not been told to obtain a COVID-19 test by a physician.
I am currently NOT waiting for COVID-19 test results.
I have not been asked to quarantine by a public health department or Ferguson-Florissant School District due to being a close contact of a person with a confirmed case of COVID-19 in the past 10 days (close contact = less than 6ft. apart for longer than 15 minutes).