Health Screening

Name*
Email Address*
Phone Number*
Have you had close unprotected contact with a confirmed or probable case of COVID-19?*
"Close" is defined as <6 feet; "unprotected" means that proper Personal Protective Equipment (PPE) were NOT followed (gloves, mask, eye shield, gown, etc.)
Have you or someone with whom you have been in close proximity traveled to a quarantined state in the last fourteen (14) days?*
Do you current have any of the following symptoms that cannot be attributed to another health condition: fever, cough, or difficulty breathing / shortness of breath?*
Please record your temperature (F) NOW*
By clicking "submit" you are declaring that all the responses given are true and accurate.
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