Covid-19 Student Screening Form
  • In compliance with the Stay at Home 2.0 universal guidelines enacted by the State of New Hampshire on May 1, 2020, all CCSNH Students and Guests who have been scheduled to be onsite must be screened daily prior to reporting to class. This screening must be completed by students only on days when they are scheduled to be onsite.
  • Section 1

  • MM slash DD slash YYYY
  • :
  • Section 2

  • NOTE: Healthcare workers caring for COVID-19 patients while wearing appropriate personal protective equipment should answer "no" to this question.
  • If you answered yes to any of the questions above or have a temperature that exceeds 100.4 degrees Fahrenheit, you will need to leave the college and report home. You will not be permitted to return to on-site coursework until you are free of fever, and any other symptoms for at least 72 hours, without using fever reducing or symptom altering medication. AVPASA Laura LeMien will be contacting you.
  • Section 3

  • You will be sent a confirmation that you submitted this form. Please present this confirmation from your cell phone when you arrive to campus. Thank you.