COVID-19 Health Screening form

  • COVID-19 Health Screening form

    As a safety precaution for all users of PBT facilities, we require everyone to submit this health screening prior to entering the building/campus each day.

    Please answer the following questions prior to your arrival at PBT. If you answer YES to any of the health screening questions, you must stay home. If you answer YES to any of the health screening questions, discontinue the survey and follow Allegheny County Health Department guidance (https://www.alleghenycounty.us/Health-Department/Resources/COVID-19/COVID-19.aspx) for next steps. Please also email the School inbox, PBTSchool@pittsburghballet.org, to notify that you were unable to pass the health screening. You needn't give specific details, just that you were unable to pass the health screening.
  • If you are completing this on behalf of your child/dependent, indicate your child/dependent's name, and complete the form based on your child/dependent's status.
  • If you are completing this on behalf of your child/dependent, indicate your child/dependent's level. If you are completing this form for the Community Division, please indicate "community".
  • If you are completing this on behalf of your child/dependent, indicate your email address.
  • Close physical contact is defined as being within 6 feet of an infected/symptomatic person for a cumulative total of 15 minutes or more over a 24-hour period starting from 48 hours before illness onset (or, for asymptomatic individuals, 48 hours prior to test specimen collection).
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  • If you completed this on behalf of your child/dependent, indicate your name.
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