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COVID-19 Health & Welfare Questionnaire
To be filled out every day by every vendor & vendor employee
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Booth Section & Number or Booth Name
*
Your answer
Have you been exposed to COVID-19 in the last 14 days?
*
Yes
No
Have you presented any symptoms for COVID-19 in the last 2-14 days? Check all that apply
*
Fever
Shortness of Breath
Sore Throat
Cough
New Loss of Taste or Smell
Loss of Appetite
Chills
Muscle Pain
None
Required
Today's Date
*
MM
/
DD
/
YYYY
By entering your initials in the box below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge
*
Your answer
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