EMPLOYEE / VISITOR COVID-19 Screening Form

*Note: COVID-19 Symptoms include:
Fever or chills	Cough
Shortness of breath or difficulty breathing	Fatigue
Muscle or body aches	Headache
New loss of taste or smell	Sore throat
Congestion or runny nose	Nausea or vomiting
Diarrhea

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EMPLOYEE / VISITOR COVID-19 Screening Form

EMPLOYEE / VISITOR COVID-19 Screening Form

STOP! DO NOT ENTER CAMPUS OR ATTEND CLINICALS! PLEASE SUBMIT THIS FORM AND CONTACT YOUR SUPERVISOR

STOP! DO NOT ENTER CAMPUS OR ATTEND CLINICALS! PLEASE SUBMIT THIS FORM AND CONTACT YOUR SUPERVISOR

STOP! DO NOT ENTER CAMPUS OR ATTEND CLINICALS! PLEASE SUBMIT THIS FORM AND CONTACT YOUR SUPERVISOR

STOP! DO NOT ENTER CAMPUS OR ATTEND CLINICALS! PLEASE SUBMIT THIS FORM AND CONTACT YOUR SUPERVISOR