Form - site

Have you experienced a fever of 100.4 F or greater in the past 10 days?

Yes No

Have you received a positive result from a COVID-19 test within the past 14 days?

Yes No

Have you been in contact with anyone while they had COVID-19 or symptoms of COVID-19 in the past 14 days?

Yes No

Have you experienced any of the following symptomps within the past 14 days? Check all that apply.

Cough Shortness of breath Sore throat Runny nose None of the above

Health Check System