COVID-19 WEEKLY HEALTH CHECK-UP

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Participating Vendors of SoCo Select Farmers & Makers Market.
Free Covid-19 tests are available through curative.com

Your Company Name *

Your Name *

Has anyone in your household or work space experienced any of the following symptoms in the past 48 hours * *

Fever

Chills

Cough

Shortness Of Breath or Difficulty Breathing

Fatigue

Muscle Or Body Aches

Headache

Loss Of Taste Or Smell

Sore Throat

Congestion Or Vomiting

None of the above

Required

Within the past 14 days, has anyone in your household or work space been in close physical contact (6 feet or closer for at least 15 minutes) with a person who's tested positive for COVID-19 or with anyone who has symptoms consistent with COVID-19? * *

YES

Are you or anyone in your household or work space currently waiting on the results of a COVID-19 test? * *

YES

If you tested positive for Covid-19 in the last month, have you tested negative using the "Rapid Test" (test for antigens in your body) since then? CVS has the 15 min Rapid Test. Please forward results to us. https://www.cvs.com/minuteclinic/covid-assessment

YES

I HAVE NOT TESTED POSITIVE

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By checking the box below, I acknowledge that all statements above are answered truthfully. * *

I understand and acknowledge

Required

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