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Daily COVID-19 Assessment

Daily COVID-19 Symptom Assessment

To prevent the spread of Coronavirus and reduce the potential risk of exposure to co-workers and customers, all employees and visitors are required to complete and submit this daily symptom assessment before entering the school. If you do not have access to internet outside of work, you are required to complete this COVID-19 symptom assessment within 15 minutes of entering the school.

Please answer each question truthfully and to the best of your ability. This assessment is the first step for us to take precautionary measures to help you and fellow co-workers and customers.

1. Please provide your first name and last name: *This question is required.

2. Please answer the following: *This question is required.

Space Cell	Yes	No
Have you tested positive for COVID19 in the last 10 days?	Have you tested positive for COVID19 in the last 10 days?: Yes	Have you tested positive for COVID19 in the last 10 days?: No
Are you currently waiting on the results of a COVID19 test because of possible COVID-19 exposure?	Are you currently waiting on the results of a COVID19 test because of possible COVID-19 exposure?: Yes	Are you currently waiting on the results of a COVID19 test because of possible COVID-19 exposure?: No
Have you been in prolonged close contact at home/work, or staying in the same household with someone who has been ordered by a medical professional to be tested for Coronavirus, or quarantine or isolate themselves because of Coronavirus?	Have you been in prolonged close contact at home/work, or staying in the same household with someone who has been ordered by a medical professional to be tested for Coronavirus, or quarantine or isolate themselves because of Coronavirus?: Yes	Have you been in prolonged close contact at home/work, or staying in the same household with someone who has been ordered by a medical professional to be tested for Coronavirus, or quarantine or isolate themselves because of Coronavirus?: No
Have you traveled outside of Negros Occidental in the last 10 days?	Have you traveled outside of Negros Occidental in the last 10 days?: Yes	Have you traveled outside of Negros Occidental in the last 10 days?: No
Have you experienced any of the following symptoms that might be related to COVID-19 in the past 48 hours? These are fever/chills, cough, difficulty breathing, fatigue, muscle or body aches, headache, loss of taste or smell, sore throat, congestion or runny nose, nausea, diarrhea, or vomiting.	Have you experienced any of the following symptoms that might be related to COVID-19 in the past 48 hours? These are fever/chills, cough, difficulty breathing, fatigue, muscle or body aches, headache, loss of taste or smell, sore throat, congestion or runny nose, nausea, diarrhea, or vomiting.: Yes	Have you experienced any of the following symptoms that might be related to COVID-19 in the past 48 hours? These are fever/chills, cough, difficulty breathing, fatigue, muscle or body aches, headache, loss of taste or smell, sore throat, congestion or runny nose, nausea, diarrhea, or vomiting.: No
Have you received vaccination for COVID19?	Have you received vaccination for COVID19?: Yes	Have you received vaccination for COVID19?: No

A YES answer to any of the question above requires you, the employee or visitor, TO IMMEDIATELY STAY AT HOME for 14 days and separate yourself. You are NOT TO ENTER any JJS Castleson campus or property. Employees or visitors are restricted from physically coming to school. For questions, immediately contact Ms. Cora, your supervisor, or email vpjjscastleson@gmail.com.