Little Red Health Check
Please fill out the following form:
Last Name *
First Name *
Have you experienced any of the following symptoms in the last 24 hours? * *
Required
In the last 14 days, have you been in contact with someone who has tested positive for COVID-19? * *
If you have been in contact with someone who has tested positive for COVID-19 or if you are experiencing ANY of the symptoms listed above, please stop and go home. By checking the box below, I attest to the fact that these questions have been answered truthfully and to the best of my ability. * *
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy