Croatoan COVID-19 Screening

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Croatoan COVID-19 Screening - 2021/2022

This form is used to capture Covid -19 screening responses for participants attending in person classes held by NCRCFE Croatoan.

This form should be completed before the scheduled start time of a class.

NOTE: If you answer Yes to any of these questions, please do not attend in person classes. Self-isolate until you have been advised that you have had a negative COVID-19 test result, or until at least 14 days after symptoms have disappeared.

Thank you for your cooperation!

Full name of person filling in this form. *

At least one form of contact information, like a phone number or e-mail address *

Full names of any other persons applicable also completing this assessment under this entry (for families, if applicable)

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