JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Paraeducator Self-Screening
IF YOU HAVE A TEMPERATURE OF MORE THAN 100.4 DEGREES OR ANSWER "YES" TO ANY OF THE SYMPTOMS PLEASE CALL 509-665-2649 AND RESCHEDULE YOUR PARAEDUCATOR TESTING APPOINTMENT.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email address
*
Your answer
First and Last Name
*
Your answer
Testing Date:
*
MM
/
DD
/
YYYY
Temperature day of scheduled appointment:
*
Your answer
In the last 24 hours have you experienced any new:
*
Cough
Shortness of Breah
Sore Throat
Muscle Aches
Loss of Smell
Headache
None of the Above
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of North Central ESD.
Report Abuse
Forms
