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COVID-19 Screening
In effort to prevent the spread of COVID-19, and to protect the health of students, staff/faculty, and guests in our community, COVID-19 Screening is required for everyone entering campus. Please complete all questions in the survey below.
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* Indicates required question
Email
*
Your email
First Name
Your answer
Last Name
Your answer
Phone Number (best way to contact you immediately in case of emergency)
Your answer
Please identify yourself:
Guest/Visitor
Faculty/Staff
Student Worker
Other:
Clear selection
What day are you coming to our campus?
MM
/
DD
/
YYYY
Do you have a face mask/cloth mask that you will be bringing with you to use while on campus?
Yes
No
Other:
Clear selection
Now, or in the past 2 weeks - have you experienced any of the following symptoms?
Yes
No
Cough
Shortness of breath or difficulty breathing
Fever/chills
Sore throat
Muscle aches or headache
Malaise (fatigue)
Recent loss of smell or taste
Have you had any nausea, vomiting or onset of diahrrhea within the last 2 days?
Yes
No
Cough
Shortness of breath or difficulty breathing
Fever/chills
Sore throat
Muscle aches or headache
Malaise (fatigue)
Recent loss of smell or taste
Have you had any nausea, vomiting or onset of diahrrhea within the last 2 days?
Within the last 2 weeks, have you been in close contact with someone who is under investigation or tested positive for COVID-19?
Yes
No
Other:
Clear selection
What is your current body temperature (in degrees Fahrenheit)?
Your answer
Send me a copy of my responses.
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