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ORU Wellness Check
Complete before entering campus or university facilities.
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1
Name
*
This field is required.
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2
Email
*
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example@example.com
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3
Personnel Status
*
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Faculty
Staff
Student
Guest
Contractor
Faculty
Staff
Student
Guest
Contractor
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4
Date
*
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Please verify date before moving
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Date
Month
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Year
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Hour
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50
40
00
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Minutes
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5
Q1 -
Are you experiencing symptoms consistent with COVID-19 including fever of 100.4 degrees or higher or chills, persistent cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, nausea or vomiting, diarrhea, or loss of taste/smell?
*
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YES
NO
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6
Q2 -
Without social distancing or wearing a mask, have you been within six feet of a sick person with COVID-19 for 15 minutes or more in the past 14 days and/or are you actively caring for a person sick with COVID-19?
*
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YES
NO
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7
Q3 -
Do you have a mask or scarf to wear in public places when social distancing isn't possible?
*
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YES
NO
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8
Score
Pass
Fail
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9
Image Field
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