•  Address:
    44001 Garfield Road
    Clinton Township, MI
    48038
  •  Building Maps

Form

Answer these questions to check if you are allowed to enter a MISD facility.

Section 1

In the last 24 hours, have you developed any of the following symptoms that are new/different/worse from baseline of any chronic illness:

Cough
Shortness_of_breath_difficulty_breathing
New_Loss_of_Taste_or_Smell

Section 2

In the last 24 hours, have you developed any of the following symptoms that are new/different/worse from baseline of any chronic illness:

Fever
Chills
Headache
Sore_Throat
Runny_Nose
Body_Aches
Fatigue
Nausea
Vomiting
Diarrhea

If you answer YES to any of the symptoms listed in Section 1, OR YES to two or more of the symptoms listed in Section 2, please do not go into work. Self-isolate at home and contact your healthcare provider for direction and possible testing for COVID-19.

In the past 14 days have you:

COVID_19_tested
Contact_with_COVID_19_positive_patients_in_last_14_days


Items with an asterisk (*) are required