Navarro College - Screening Questionnaire
You must complete this form if you suspect you have COVID or have been in close contact with someone who has COVD.
Please select your status
Student/Employee ID Number
Accompanying Persons - If there will be an additional person with you (such as a family member), please list their name. They will also need to complete a pre-screening form.
Enter accompanying person
Date you will be on campus
Activities being performed - Please describe what you will be doing on campus. Be sure to add which building(s) you will be going to. ·
Have you tested positive for COVID-19 or are you awaiting results from a COVID-19 test? (If testing was done solely out of precaution or required for facility entrance such as hospital, nursing home, etc., you may answer this question “no”.
Are you feeling sick? Based on Guidance provided by State health authorities check yes if you are experiencing new or worsening symptoms of the following: Cough, Shortness of breath or difficulty breathing, Chills, Repeated shaking with chills, Muscle pain, Headache, Sore throat, Loss of taste or smell, Diarrhea, Feeling feverish or a measured temperature greater than or equal to 100.0 degrees Fahrenheit. ·
Are you in a home with, or have been in close contact with someone who is sick? Based on Guidance provided by State health authorities check yes if you came within 6 feet or exposed to cough/sneeze from someone with confirmed COVID-19.
Have you received all required doses for a COVID-19 vaccine?
Should be Empty: