New COVID-19 Campus Visit Screening

COVID-19 Campus Visit Screening
Please submit this form each day that you need to visit campus.
DateOnly

Month Day Year
Date
First Name *
Last Name *
Email *
Students and staff must use their KC email address, all vendors and visitors please use the email address that you regularly correspond with the College

Reason for Visiting Campus *
What sport are you visiting for? *
What is the reason for visiting? *
Student / Employee ID Number *

You have selected "None of the Above" and at least one symptom from the list above. Please review your choices for this question. If you do not have any symptoms and selected one by accident, please uncheck it before proceeding.

If you are currently experiencing symptoms, please unselect "None of the Above" and continue the form.
TRAVEL ADVISORY

If you are returning to campus after travel to a state or country that was identified by the CDC with a COVID-19 travel advisory while you were there, please refer to the CDC or your local health department for information about suggested self-quarantine guidelines for travelers.

When on-campus or preparing to visit any KC campus locations, please review and adhere to all posted guidelines. A facemask is required, please maintain social distancing and do not congregate in large groups.”
*

I have reviewed and verify that all of the information entered above is true
Symptom Score
Calculation
Score
Reply Address
example@example.com
Your responses may require follow-up, please provide a phone number where you can be reached by our team. *

Area Code Phone Number
Date *

Month Day Year
Date Hour Minutes AM/PM Option
You will need to choose either "None of the Above" OR a list of symptoms from the list above before being able to submit.
*If you receive an error upon submission that only one entry is allowed, please refresh this page in your browser and confirm that the date field above reads the correct date and time.
UniqueCode
Should be Empty: