JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
COVID-19 Screening Questionnaire If you answer YES to any of these questions, you MUST NOT attend class.
* Required
Sign in to Google
to save your progress.
Learn more
* Indicates required question
What is your name?
*
Your answer
Do you or anyone you are in close contact with have a fever, cough, shortness of breathe, difficulty of breathing, sore throat, chills, difficulty swallowing, feeling unwell, runny nose?
Yes
No
Clear selection
Have you or anyone you are in close contact with traveled outside of the country within the last 14 days?
Yes
No
Clear selection
Have you or anyone you are in close contact with being tested for or has tested positive for COVID-19?
Yes
No
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
