Covid-19 Student Screening Form
  • In compliance with the Safer at Home universal guidelines enacted by the State of New Hampshire on June 15, 2020, CCSNH students who have been scheduled to enter a CCSNH facility must be screened daily prior to entering the facility. This screening must be completed only on days when students are scheduled to come onsite. Please complete the following screening information and return the completed form as directed by your college. The information collected will be used only for the purpose of maintaining safe and healthy business operations and shall be maintained as confidential.
  • Section 1

  • Date Format: 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 100.0 degrees Fahrenheit, you will not be permitted to enter a CCSNH facility until you are free of fever, and any other symptoms for at least 72 hours, without using fever reducing or symptom altering medication.
  • 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.