Perpich Center Visitor Health Screening Questionnaire (COVID-19) - March 2022
In an effort to prevent the spread of COVID-19 and reduce the risk of exposure to Perpich Center for Arts Education (PCAE) workforce, students and visitors, we are asking all visitors who wish to enter Perpich buildings to complete the following screening questionnaire prior to being authorized to enter the workplace. You are not legally required to answer the screening questions; however, if you do not answer the screening questions, you will not be permitted to enter Perpich Center buildings.

Please complete on the day of your visit, prior to entry.

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Visitor Name: *
Visitor Phone Number:   *
Visitor Email: *
Family/Visitor Company/Organization: *
Name of Perpich Host (who are you here to see?): *
The first question asks about whether you’ve recently had COVID-19 symptoms.  These symptoms may appear 2-14 days after you are exposed to the virus that causes COVID-19.  Symptoms include: Fever or chills. Cough. Shortness of breath or difficulty breathing. Muscle or body aches. Headache. New loss of smell or taste. Sore throat. Congestion or runny nose. Nausea or vomiting. Diarrhea. -------  Have you had any of the above symptoms within the past 48 hours? *
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