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COVID-19 Visitor Questionnaire
In an effort to reduce the risk of COVID-19 exposure to Integrity's employees, all visitors must complete the following screening questions:
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* Indicates required question
First & Last Name
*
Your answer
Person at Integrity you are Visiting or Reason for Visit?
*
Your answer
Have you traveled to a high risk area or been in close contact with anyone who has traveled to a high risk area within the last 14 days?
*
Yes
No
Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days?
*
Yes
No
Have you experienced any cold or flu-like symptoms in the last 14 days?
*
Cold or flu-like symptoms: fever (temperature above 100.4° F, per CDC), cough, shortness of breath or other respiratory problem
Yes
No
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