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HFD Daily COVID-19 Assessment
COVID-19
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* Indicates required question
Last Name
*
Your answer
First Name
*
Your answer
Is your fever greater than or equal to 100.4' F
*
Yes
No
Maybe
Are you experiencing any of the following? (That is not a normal symptom you would normally experience)
*
Cough or shortness of breath?
Chills?
Sore throat?
Muscle aches?
Fatigue?
No
Other:
Required
Have you lost your sense of smell or taste?
*
Yes
No
Maybe
Have you had close contact with someone who has tested positive for COVID-19?
*
Yes
No
Maybe
I hereby swear all questions were answered to my best ability and I will completely comply with any contact tracing if found to be exposed.
*
Electronic Signature of member
Required
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