Oxford Community Schools

Health Questionnaire

The safety of our employees, students, families, and contractors remain Oxford Community Schools' overriding priority. To prevent the spread of COVID-19 and reduce the potential risk of exposure to our communitiy we are conducting a simple screening questionnaire.

Your participation is important to help us take precautionary measures to protect you and everyone in our buildings. Thank you for your time!

Visitor Information

*Full Name

*Visitor Type

*Location

Cell Phone Please enter phone number only, formatting will apply automatically.

*Self-Declaration (All answers required.)

Within the past 10 days, have you experienced any symptom that is unrelated to a preexisting condition and designated as high-risk for COVID-19 (i.e. new persistent cough, shortness of breath, difficulty breathing, new loss of taste or smell) and have NOT received a negative COVID-19 PCR (non-rapid) test?

Within the past 10 days, have you experienced two or more cold or flu-like symptoms listed below that are unrelated to a preexisting condition and have NOT received a negative COVID-19 PCR (non-rapid) test? ○ Fever (100.4 degrees or higher) ○ Headache ○ Diarrhea (2x in 24 hours) ○ Chills ○ Sore throat (pins and needles) ○ Nausea or vomiting (2x in 24 hours) ○ Muscle aches ○ Fatigue ○ Congestion or runny nose

Within the past 14 days, have you had *close contact with anyone diagnosed with COVID-19? *Note: “close contact” is defined as being within six feet of a positive case for 15 minutes or more over a 24-hour period during the period in which the positive case was contagious.

Is anyone in your household ill and/or awaiting COVID-19 test results?