AAPS Staff COVID-19 Prescreening Tool

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Email *

Your first and last name *

Building/campus you are entering today: *

In the past 24 hours, have you experienced any of the following NEW or UNEXPECTED symptoms: *

Fever of feeling feverish (chlls, sweating)

New cough (excluding a chronic cough related to another medical condition other than COVID-19)

Difficulty breathing or shortness of breath

Sore throat

Muscle aches or body aches

Vomiting or diarrhea

Loss of sense of taste or smell

Congestion or runny nose

I have not experienced any of the above symptoms.

Required

If you checked any one of the above symptoms, please do not enter the AAPS building/campus. Call your health care provider, seek COVID-19 testing, and isolate at home until your test results come back.

In the past 14 days, have you been in CLOSE CONTACT with anyone with symptoms of COVID-19 or diagnosed with COVID-19? (Close contact = Less than 6 feet for more than 15 minutes over the course of 24 hours, with or without a mask in place):

Yes

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If you answered "yes," please do not enter the AAPS building/campus. (Stay home and contact your supervisor. You may be put into quarantine by a health department.)

Have you recently had a COVID-19 test because you were a close contact of a known case or were experiencing COVID-19 symptoms? *

Yes

If you answered yes to the question above, contact your supervisor and stay home until you have received your test results.

I certify and confirm that the answers I have provided in this form are complete, truthful and accurate. *

Yes

If you checked symptoms (that are new or can't be explained by a known condition) please stay home, seek COVID-19 testing, and call your health care provider for medical advice. If are experiencing symptoms or you answered yes to any of the questions, please also contact your building administrator/supervisor as soon as possible.

By entering the building, you are acknowledging that none of the above applies to you or a family member.
Updated 02-01-2021

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