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SWAEC VISITOR COVID QUESTIONNAIRE
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Email
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Your email
Date
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MM
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DD
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First and Last Name
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Your answer
I have had a fever of 100.4°F within the last 14 days.
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YES
NO
I am experiencing at least one of these symptoms: cough, shortness of breath, respiratory infection, sore throat, loss of sense of taste or smell.
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YES
NO
I have had contact with someone that has lab-confirmed Novel Coronavirus within 14 days or have been ordered to self quarantine.
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YES
NO
I verify that the above information is true and if I answered yes to any of the above questions I will not come to the cooperative.
*
YES
NO
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