EHS Visitor Health Survey

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The GWD50 Pandemic Response Team has created this Daily Health Survey that must be completed by visitors. This form MUST be completed prior to your arrival at EHS.

Remember, when you arrive on campus, it is extremely important that you practice social distancing. Please maintain at least 6ft distance between you and other guests. Thank you for your help in keeping our students and staff healthy and safe.

If you check "YES" to any of the questions below, please do not enter the building.

Email *

Name

What is the reason for your visit?

What is your temperature today? *

In the past 24 hours have you had fever? *

Yes

In the past 24 hours have you had chills? *

Yes

In the past 24 hours have you had an existing cough? *

Yes

In the past 24 hours have you experienced shortness of breath? *

Yes

In the past 24 hours have you experienced extreme fatigue? *

Yes

Have you been exposed to anyone who has been sick or diagnosed with COVID-19 in the past 14 days? *

Yes

Send me a copy of my responses.

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