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!

Effective April 20, 2021 Oxford Community Schools will change their notification procedures for building entrants when COVID-19 cases arise. Information about any current or past COVID-19 cases can be found on the district communication page.

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 and have NOT tested negative following new CDC health protocols? *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 currently ill with COVID-like symptoms as outlined in the previous questions or awaiting COVID-19 test results following such symptoms?