At present, this form is required to be completed by EVERY individual student and on every day they are attending school on-campus. It is important that the form be submitted PRIOR to getting on a school bus or coming onto campus. We suggest that you secure a thermometer and set up a morning routine that allows time to complete a form per student in a family. If you have questions or a problem completing the form please contact your building nurse.
*Contact Type:
Contact ID:  (optional)
*First Name:
*Last Name:
*Phone Number:
*Confirmation Email:

In the past 10 days: Have you had any symptoms of COVID-19? (Fever, rash, chills, cough, shortness of breath/difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting/diarrhea).

In the past 14 days: Have you tested positive for COVID-19?

In the past 14 days, have you had close contact with a confirmed or suspected COVID-19 case?

Based upon Governor Cuomo's new Executive Order 205, effective, June 25, 2020, have you traveled to a state with a positive test rate higher than 10 per 100,000 residents or higher than a 10% test positivity rate, over a seven day rolling average? If your answer is yes, upon re-entering New York State, you must quarantine for a period of 14 days and must not access the building during the quarantine period. As of 08/13/2020, please refer to the list of states that meet the requirements for the mandated quarantine on the following website. If you travel outside of the state please contact the nurse to verify the status of that country/place.

Was your temperature over 100 degrees F. this morning? If "YES" please contact your health care provider and the nurse of your building. Do Not report to school.

Are you experiencing any of the symptoms or scenarios above?