Daily Self-screening Forms: Faculty • Staff/Student-Employee • Student • Guest

for Faculty, Staff and Student Employees

The California Department of Public Health mandates the enactment of enhanced mitigation measures to slow the spread of COVID-19, a communicable disease. Stanislaus State’s Injury and Illness Prevention Program applies to all University employees, volunteers, students, and visitors. It applies to all University programs and activities.

The Daily Screening Protocol is mandated by the COVID-19 Interim Guidelines for Institutions of Higher Education.

County Health Order (Current to CDC Guidelines)

The California Department of Public Health requires all Higher Education Institutions to conduct symptom screening of faculty, staff and students for potential COVID-19 symptoms before they enter campus. If someone has a temperature at or above 100°F or meets the symptom criteria, they must be prohibited from entering the campus.

Symptom Screening Process

Employee Screening Process:

  • Every employee must complete the Daily Screening Form each day before coming to campus.
  • If an employee answers “NO” to all questions, a message will advise the employee they are CLEARED to come to campus.
    • The employee’s supervisor, or Dean for Faculty, will receive an automatically generated email indicating that the employee is CLEARED to come to campus.

Exceptions to Screening Process:  

  1. Individuals who work for a contractor/vendor confirmed by the COVID Response Coordinator (“CRC”) to be conducting daily screenings of their own employees under State public health requirements are exempt from completing the form.
  2. If an employee cannot complete the Daily Screening Protocol, they can contact the CRC to discuss a reasonable accommodation.

Community Responsibilities

Employee/Faculty Responsibilities:

  • Not to come to campus if experiencing symptoms related to COVID-19.
  • Complete the COVID-19 Daily Screening Form before coming to campus.
  • Employees do not have to own or buy thermometer; if they do not have one available at home, they can complete and submit the screening form based on self-assessment of symptoms.
  • If not cleared, communicate with their supervisor as they would for any need to use sick leave. Employees can contact the Leaves Specialist for their leave options.

Supervisor/Dean Responsibilities:

  • Develop departmental procedures to ensure effective compliance with the IIPP and the daily screening requirement as they relate to operations under their control. More information about the responsibilities of supervisors can be found in the IIPP on page 4.
  • Consistently communicate that employees must complete the Daily Screening Form before coming to campus.
  • If an employee asks questions when calling in sick, you can answer questions. If you do not know the answer to a COVID-related question, please contact the CRC.
    • If an employee lets you know they answered “Yes” to a daily screening question, reiterate they need to stay home and will be contacted by the CRC.
  • Maintain the confidentiality of the daily reporting status of any employee or faculty.
  • Not stigmatize or retaliate against any employee for COVID-19 related reasons.

Program Administration

Supervisors and Deans are responsible for making sure they receive a “CLEARED” (email, hard copy or call) for each employee working on campus each day.
Employees who enter any campus building and/or report to work on campus without first completing the screening form will be given a reminder, and repeated violations will be addressed through standard processes to address failure to adhere to safety policies.


All employees will be notified that self-screening is being implemented, the criteria for workplace access, and a reminder not to enter campus before screening. All supervisors (and any employees requesting such) will be provided with a copy of this protocol.

Last updated: February 18, 2021