COVID-19 Building Pre-Entry Screening Form

Date *

Building *

Choose the building you are reporting to in the dropdown below

Name *

First Last

Email *

After you complete the questionnaire you will receive an on-screen message and an emailed message. As you enter any District building you must present the on-screen message or the email message on your cellphone to be allowed in the building.

Enter Email Confirm Email

Department/Office *

Choose the department/office you report to in the dropdown below

School *

Choose the school you report to in the dropdown below

District Employee ID Number *

Please enter last 5 digits of your Employee ID

In the past 24 hours, have you had one of the following symptoms unrelated to a pre-existing medical condition: frequent cough or shortness of breath? *

Yes
No

In the past 24 hours, have you had TWO of the following symptoms unrelated to a pre-existing medical condition: sore throat, chills, headache, muscle pain, new loss of taste or smell? *

Yes
No

In the past 24 hours, have you experienced a fever of 100.4℉ or above? *

Yes
No

Have you been in close physical contact with someone who tested positive for COVID-19 within the past 14 days? *

Yes
No

User Acknowledgement *

I acknowledge the terms below.

I understand the electronic submission of this form effectively serves as my signature and I certify that I have accurately completed the COVID-19 Building Pre-Screening Form and will comply with the outcomes identified above. I understand I may not enter at any District building if I answered YES to any of the questions above. I acknowledge the terms above and certify that I have completed the COVID-19 screening questions and will comply with the requirements identified.

CAPTCHA

The School District of Philadelphia is looking for your feedback about how virtual learning is going for your student. Take the 5-minute survey HERE.

Are you ready to #LogOnPHL? Visit our Back-to-School Resource Hub!

Looking for help? Find School and Central Office information for families HERE!

New Student Registration for all grades K-12 is OPEN! Learn more.

Office Menu:

Search the site:

Office of
Employee Health Services

COVID-19 Building Pre-Entry Screening Form

The School District of Philadelphia is looking for your feedback about how virtual learning is going for your student. Take the 5-minute survey HERE.

Are you ready to #LogOnPHL? Visit our Back-to-School Resource Hub!

Looking for help? Find School and Central Office information for families HERE!

New Student Registration for all grades K-12 is OPEN! Learn more.

Office Menu:

Search the site:

Office of Employee Health Services

COVID-19 Building Pre-Entry Screening Form

Office of
Employee Health Services