Event Health Questionnaire
Please complete this mandatory self assessment prior to attending an Arch Street event. If you answer "yes" to any of the following questions, before you go anywhere please contact your health care professional.
Have you tested positive for COVID-19 in the past 14 days?
Have you had any close contact with a confirmed or suspected COVID-19 case in the past 14 days?
Do you have a temperature of 100°F or greater?
Are you experiencing any new or unexpected symptoms?
Shortness of breath
Muscle or body aches
New loss of taste or smell
Congestion or runny nose
Fever or chills
I am not experiencing any of the above symptoms
Have you traveled to any of the following states or US territories for 24 hours or longer in the last 14 days? (Alabama, Alaska, Arkansas, California, Delaware, Florida, Georgia, Guam, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, Montana, Nebraska, Nevada, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin)
Date of Completion:
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By signing and submitting this form, you certify that the above answers are true to the best of your knowledge and belief.
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