Covid-19 Daily Screening Questionnaire | Ogdensburg Free Academy

Ogdensburg Free Academy

Covid-19 Daily Health Screening Questionnaire

Employee First Name: *

Employee Last Name: *

Employee's Email Address: *

Building: *

Ogdensburg Free Academy

John F. Kennedy

Grant C. Madill

Ogdensburg City School District

Date: *

Month

Day

Year

1. Do you have a temperature of greater than 100.0˚ F?: *

Yes

No

2. Have you traveled internationally, or from a State listed on the “Mandatory Quarantine List”, in the past 14 days?: *

Yes

No

3. Have you been exposed to a person, in the past 14 days, who has been tested for Covid-19?: *

Yes

No

4. Have you tested positive for Covid-19 in the past 14 days?: *

Yes

No

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