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Let's work together to keep our students and staff healthy and our schools safe.
An important component in keeping our students and staff healthy is the daily completion of the health screener form below. Staff and parents/guardians, please complete the form as early in the morning as possible. Parents/guardians, the form must be completed for each child in the district.
Once you complete the questions, please click "
Submit
" at the bottom.
*
Contact Type:
Select Contact Type
Student
Staff
**Contact Type is Required**
Contact ID:
(optional)
*
First Name:
**First Name is Required**
*
Last Name:
**Last Name is Required**
*
Phone Number:
**Phone Number is Required**
*
Email:
**Email is Required**
**Valid Email Address is Required**
*
Confirm Email:
**Confirmation Email is Required**
**Emails Must Match**
*
School:
Select a School
Benjamin Franklin ES
Buildings & Grounds
Central Office
Copper Beech MS
District
George Washington ES
Lakeland HS
Lincoln-Titus ES
Thomas Jefferson ES
Transportation
Van Cortlandtville ES
Walter Panas HS
**School is Required**
Have you developed acute onset of any of the following symptoms in the past 24 hours:
Fever of 100.0 or more or 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
Have "you" (staff/student) tested positive for COVID-19 in the last 10 days?
Have "you" (staff/student) been in close contact with a documented COVID-19 case in the last 10 days?
Are "you" (staff/student) experiencing any of the symptoms or scenarios above?
No
Yes
**Question Must Be Answered!**