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Are you currently experiencing, or have you experienced in the past 14 days, any of the following symptoms: Fever, Cough, Shortness of breath or difficulty breathing, Sore throat, New loss of taste or smell, Chills, Head or muscle aches, Nausea, Diarrhea, or Vomiting?
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In the past 14 days, have you been in close proximity to anyone who was experiencing any of the above symptoms or has experienced any of the above symptoms since your contact?
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In the past 14 days, have you been in close proximity to anyone who has tested positive for COVID-19?
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Have you been tested for COVID-19 and are waiting to receive test results?
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In the past 14 days, have you been on a commercial flight or traveled outside of the United States?
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In the past 14 days, have you been in close proximity to anyone who has been on a commercial flight or traveled outside of the United States?
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Is there any reason why you feel you are at higher risk of contracting COVID-19 or experiencing complications from COVID-19 by entering the facility? If “yes”, please provide a brief explanation.
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