COVID-19 Screening Questions

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Coronavirus Disease (COVID-19) has been reported in every state and in countries around the world. COVID-19 can cause respiratory illness.
In order to protect you and others, we are asking about symptoms and exposure to COVID-19 before you participate in this group activity.

Please answer the following questions:

Email *

Name *

Trip Location *

Trip date *

YYYY

Do you have a fever? *

Yes

Do you currently have cough or shortness of breath? *

Yes

In the past 14 days, have you (or someone in your household) traveled internationally? *

Yes

In the past 14 days, have you or someone in your household been diagnosed, tested or quarantined under doctor’s orders for COVID-19? *

Yes

In the past 14 days, have you been in close contact with someone who has been diagnosed, tested or quarantined under doctor’s orders for COVID-19? *

Yes

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