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Covid-19 Health Screening
This form is required to be completed BEFORE entry into the Institute. It must be completed before EACH entry (except for same day re-entry).
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了解详情
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Full Name
*
您的回答
Have you had any of the following symptoms within the last 10 days?
*
Yes
No
Fever (at or over 100.4F or 38C
Chills
Cough
Shortness of Breath/Difficulty breathing
New loss of taste or smell
Yes
No
Fever (at or over 100.4F or 38C
Chills
Cough
Shortness of Breath/Difficulty breathing
New loss of taste or smell
Have you had close contact with a person known to be infected with or suspected to have Covid-19 within the last 14 days?
*
Yes
No
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