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NYC Health Screening Questionnaire DOE
[PDF] NYC Health Screening Questionnaire DOE PDF
No. Of Pages: 01
PDF Size: 165 KB
Language: English
Category: General

NYC Health Screening Questionnaire DOE

Before entering DOE facilities, all DOE students, employees, and visitors must complete a health screening. Each day of your arrival, you must complete this health screening. If you have not completed the online health form, you will be asked to answer the questions below when you enter the facility. To remind you, all DOE employees must be vaccinated before entering our schools.

  1. Have You Experienced Any Symptoms of COVID-19, Including a Fever of 100.0 Degrees F or Greater, a New Cough, Sore
    Throat, Loss of Taste or Smell or Shortness of Breath That Started in the Past 10 Days?
    No. Go to the Next Question.
    Yes, and I Have Received a Negative Result From a COVID-19 Diagnostic Test Performed by a Health Care
    Provider or I Am a Student or School-Based Staff Member Who Received Two Negative Results From a Takehome Test Taken at Least 24 Hours Apart Since the Onset of Symptoms and Have Only Mild Symptoms (No
    Runny Nose; If Cough, Cough Minimal and Non-productive; Fever-Free for 24 Hours Without the Use Of
    Medication). Go to the Next Question.
    Yes, and I Am a School-Based Staff Member Returning on Day 6 of Isolation With Mild Symptoms (No Runny
    Nose; If Cough, Cough Minimal and Non-productive; Fever-Free for 72 Hours Without the Use of Medication),
    Wearing a Higher-Grade Face Covering Such as a kn95 or N95. Go to the Next Question.
    Yes, and I Am Not in the Categories Above. No Further Screening Is Needed. The Individual May Not Enter The
    Building.
  2. In the Past 10 Days, Have You Gotten a Positive Result From a COVID-19 Diagnostic Test? Please Note That 10 Days Is
    Measured From the Day You Were Tested, Not From the Day When You Got the Test Result.
    No. Go to the Next Question.
    Yes, and I Am a School-Based Staff Member Returning on Day 6 of Isolation With No Symptoms or Mild
    Symptoms That Are Improving (No Runny Nose; If Cough, Cough Minimal and Non-productive; Have Been
    Fever-Free for 72 Hours Without the Use of Medication), Wearing a Higher-Grade Face Covering Such as a Kn95
    Or N95. Go to the Next Question.
    Yes. No Further Screening Is Needed. The Individual May Not Enter the Building.
  3. In the Past 10 Days, Were You in Close Contact With Someone Who Tested Positive for COVID-19?
    No. The Individual May Enter the Building.
    Yes, I Was Exposed at School, and Am Taking COVID-19 Diagnostic Test(s) As Directed by My School and Have
    Not Received a Positive Result on Those Tests. If I Test Positive, I Will Begin Isolation. The Individual May Enter
    The Building.
    Yes, I Was Exposed at School but I Have Not Received a Home Test Kit. Please Contact Your School to Ensure
    You Receive a Home Test Kit Today. The Individual May Enter the Building.
    Yes, and I Am Not Fully Vaccinated Returning From Quarantine From an Exposure Outside of School on Day 8
    With Proof of a Negative Diagnostic COVID-19 Test Performed on Day 5 or Later. The Individual May Enter The
    Building.
    Yes, I Was Exposed Outside of School, but I Am Considered Fully Vaccinated. The Individual May Enter The
    Building.
    Yes, and I Was Exposed Outside of School and I Am Not Fully Vaccinated. The Individual May Not Enter The
    Building.

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