COVID-19
Pre-Screening General Health Form

 
1. Have you had signs or symptoms of a respiratory infection, such as a cough, shortness of breath, or sore throat?
2. Do you have a fever greater than 99.6°F?
3. In the last 14 days, have you been in close contact* (see below for definition) with anyone who has been tested or diagnosed with COVID-19?
4. In the last 14 days, have you been in close contact* (see below for definition) with anyone who is suspected for COVID-19 but is yet to be confirmed as a positive?
5. In the last 14 days, have you been in close contact* (see below for definition) with anyone who is ill with a respiratory illness?

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