Health Screening Form For Staff

  • Avalon Children's Montessori School COVID Screening Questions For Staff

  • Please take your temperature and record the results here

  • 1. A) Are you currently experiencing any of the following symptoms?

    If the symptom is from a known health condition that gives them the symptom, select “No”. If the symptom is new, different or getting worse, select “Yes”.

    If there is mild tiredness, sore muscles or joints within 48 hours after a COVID-19 vaccine, select “No”. If longer than 48 hours, select “Yes.”

    Anyone who is sick or has any symptoms of illness, should stay home and seek assessment from their health care provider if needed.

  • Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher and/or chills.

  • 1. B) Are you currently experiencing any of the following symptoms?

    *Symptoms include 1 or more symptoms from 1.A or 2 or more symptoms from 1.B on the screening tool

    If you have one symptom from 1.B, other household members do not have to self-isolate.

    In the context of Omicron, individuals who are previously positive in the last 90 days and not fully vaccinated are not considered equivalent to fully vaccinated.

  • If “YES”: Stay home & self-isolate.

  • If the student/child is fully vaccinated**, or public health has told you that you do not need to self-isolate, select “No.”

    If “YES”: Stay home & self-isolate.

  • If “YES”: Follow federal quarantine travel rules.

  • Date Format: MM slash DD slash YYYY