Volunteer: Daily COVID-19 Self Screening Form

All volunteers in Oakland public schools should complete this form prior to checking in at your school site each day.
Your email will be recorded when you submit this form.

Screening Questions
(1) Have you had COVID-19 in the past 10 days?

(2) Have you had close contact with anyone with COVID-19 in the past 10 days, such as a member of your household? Close contact means within 6 feet of a COVID positive person for at least 15 minutes over the course of 24 hours, even if both people were wearing masks. Close contact also includes briefer but major exposure to the COVID positive person’s respiratory droplets, such as the sick person coughing directly on you.

(3) In the past 10 days, have you had symptoms that are new, different, or unexplained by another reason (i.e. pre-existing diagnosis) including one or more of the following?
- Fever of 100 F (37.8 C) or higher
- Cough
- Severe headache
- Sore throat
- Loss of taste or smell. May present as food “tasting bad” or “tasting funny”.
- Difficulty breathing
- Vomiting or Diarrhea

NOTE: If you have gotten a COVID-19 vaccine in the past 5 days, and if your symptoms are mild (i.e., fatigue, headache, chills, pain) and temporary (i.e., lasting fewer than 2 days), then it is likely that the symptoms are side effects of the vaccine and you can answer "No" to the symptoms question.