COVID-19 Self Check Symptom Screener

COVID-19 Self Check Symptom Screener

To be completed each day you plan to come to campus
All persons coming to the Columbia College campus needs to complete and submit this form. Completion of this form indicates your consent to share information collected about you with Columbia College Health Services, YCCD, and the Tuolumne County Public Health Department to manage COVID-19 cases, including contact tracing in the case of positive cases from our campus. If you have questions about why you are providing this information, please contact Laureen Campana NP, Coordinator of Health Services at campanal@yosemite.edu or (209) 588-5204.

To be completed THE DAY you plan to come to campus.

DO NOT complete for days in the future.
Please enter the date you are coming to campus *
Please choose one of the following options *

I am a Columbia College employee I am a current student I am a visitor (or future student)
Please get Dean/Supervisor approval before coming to campus.
Your Name *

First Name Last Name
Student ID Number *
Email *
example@example.com
Contact Phone Number *

Area Code Phone Number
Symptoms of COVID 19
- Cough
- Congestion or runny nose
- Fatigue
- Feel feverish or have chills
- Headache
- Muscle or body aches
- Nausea or vomiting
- New loss of taste or smell
- Shortness of breath or difficulty breathing (seek care if yes)
- Sore throat
DO YOU HAVE ANY OF THE ABOVE SYMPTOMS, NO MATTER HOW SLIGHT THE SYMPTOMS? *

Yes No
Please do not come to campus

You answered "Yes" to the above question. It is not safe for you to come to campus at this time.
If you are feeling any shortness of breath, difficulty breathing or are feeling very unwell, please seek medical care immediatey by going to the hospital or calling 911.

Next Steps:

Please call one of the following numbers for information on symptoms, testing, isolation and quarantine guidelines.

Adventist Health COVID Triage Line (209) 535-5166 M-F 9a-5p.

COVID-19 Public Health Call Center (209) 533-7440 M-F 9a-5p.

Click Here to visit the Tuolumne County Public Health website
Please select the areas on campus you will be visiting today *

Parking Lot Only (for internet access) Alder Aspen Buckeye Cedar Dogwood Dorms/Student Housing Facilities/Maintenance Fir Fire House or Public Safety Juniper Laurel (Child Care Center) Madrone Mahogany Manzanita Maple Oak Pavilion Pinyon Poison Oak Ponderosa Redbud Sequoia Sugar Pine Symons Field Tamarack Hall (Library) Tennis Courts Toyon Willow Security Only - All campus buildings
You may come to campus

You answered "No" to the symptom question. You may come to campus at this time. Please complete the rest of this screening tool.
Should be Empty:

COVID-19 Self Check Symptom Screener

Please do not come to campus

You may come to campus