Please answer each question. You do not need to consider any chronic conditions you may have.
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Have you been told to quarantine/isolate by a medical provider or
the health department?
Are you currently awaiting COVID-19 test results?
Excluding those individuals in an occupational setting
wearing appropriate professional PPE, in the last 14 days, have you had close contact (i.e.
less than 6 feet of physical distance) for 10 minutes or more with someone who has COVID-19?
Are you experiencing a cough, shortness of breath, or
difficulty breathing which is new or not explained by a pre-existing condition?
In the last 48 hours, have you had at least two of the following
symptoms which is new or not explained by a pre-existing condition: fever, chills, repeated shaking chills,
fatigue, muscle pain, body aches, headache, sore throat, nasal congestion or runny nose, vomiting, diarrhea,
or loss of taste or smell?
Was your temperature 100.4 or above just prior to taking
By checking in, I agree that the information indicated above is correct.
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