COVID 19 Health Screening Questionaire
Welcome to the Da People's Assembly commitment March on Washington 2020. In compliance with our obligation under various public health emergency standards regarding the COVID-19Pandemic, we are implementing the following health screening for all persons riding. our Commitment Buses to Washington DC. Please answer the following questions to the best of your knowledge
Name *
Emergency Contact phone *
Temperature Boarding *
In the past 14 days have you tested positive for COVID 19?
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Experienced  any symptoms. of COVID 19 ( shortness of breath, fever, COVID 19 *
Knowingly been in close or proximate contact with someone who has tested positive or who has had symptoms of Covid-19? *
Temperature DC -Arrival *
Temperature DC -Departure *
Date *
MM
/
DD
/
YYYY
Submit
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