COVID-19 Visitor Questionnaire

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In an effort to reduce the risk of COVID-19 exposure to Integrity's employees, all visitors must complete the following screening questions:

First & Last Name *

Person at Integrity you are Visiting or Reason for Visit? *

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

Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days? *

Yes

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

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