Employee / Visitor Health Screening
Name of the Individual
*
1. Have you experienced a fever of 100.4 degrees Fahrenheit or greater, a new cough, new loss of taste or smell, or shortness of breath within the past 10 days?
*
Yes
No (Go to the next question)
2. In the past 10 days, have you tested positive for COVID-19 using a test that tested saliva or used a nose or throat swab (not a blood test)? (10 days measured from the date you were tested, not the date you received the test result.)
*
Yes
No (Go to the next question)
3. To the best of your knowledge, in the past 14 days, have you been in close contact (within 6 feet for at least 10 minutes) with anyone while they had COVID-19?
*
Yes
No (Go to the next question)
Please visit
COVID-19 Travel Advisory
Submit
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