Employee Check-in Form 2020

Linwood Public Charter School is currently checking temperatures and asking questions as employees enter the building. Fever: Any temperature 100.4 F or greater is considered a fever.

Name *

COVID-19 Health Screening

Entry TEMPERATURE- 100.4 F or greater is considered a fever. *

Temperature in Fahrenheit (F)

Have you had any of the following symptoms in the last 24 hours?:
-Dry Cough
-Shortness of Breath
-Loss of Taste or Smell
-Fever of 100F (38.0C) or Greater

Response to Symptom Question *

Have you had close contact with anyone who has COVID-19 in the past 14 days?:
(within 6ft for 10 or more minutes)

Response to Contact with COVID-19 Question *

Notes/ Comments

If "YES" to any of these questions, the employee should NOT enter the building and return home.

This form will be completed as employees enter the building.

Fever: Any temperature 100.4 F or greater is considered a fever.

Employee Check-in Form 2020

COVID-19 Health Screening

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