Visitor Health Registration

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To prevent the spread of COVID and related viruses, all visitors must fill out this survey to identify what symptoms they have recently had, to preclude allowing infected individuals on campus.

Para evitar la propagación del COVID y otros virus relacionados, todos los visitantes deben diligenciar esta encuesta con el fin de identificar los síntomas que han tenido recientemente y así evitar que haya personas infectadas en el campus.

Visitor type / Visitante *

Visitor Category

ECA Family / Familia ECA

Contractor / Service Provider - Contratista / Proveedor

Other:

Required

Name *

Name / Nombre

ID Number *

ID Number / Número de Identificación

Health Coverage / *

Colombian EPS

International

Other:

Provide Name of the company *

COVID-19 Control

Indicate whether you have had any of the following symptoms within the last 14 days. / Indique si ha presentado alguno de los siguientes síntomas en los últimos 14 días.

Fever *

Have you had a fever? / ¿Ha tenido ﬁebre? (38° C / 100.4° F or higher)

Yes

Breathing *

Have you had difficulty breathing? / ¿Ha sentido diﬁcultad para respirar?

Yes

Cough *

Have you had a recurring cough? / ¿Ha tenido tos persistente?

Yes

Taste/Smell *

Have you lost your sense of taste or smell? / ¿Siente que ha dejado de percibir olores y/o sabores?

Yes

COVID Contact *

Have you had contact or do you live with anyone with COVID, suspected or confirmed? / ¿Ha tenido contacto, o vive con alguien sospechoso o conﬁrmado de tener COVID-19?

Yes

Flu-like Symptoms *

Have you had flu-like symptoms or a runny nose? / ¿Ha tenido congestión nasal?

Yes

Sore Throat *

Have you had a sore throat? / ¿Ha sentido dolor de garganta?

Yes

Headache *

Have you had a headache? / ¿Ha sentido dolor de cabeza?

Yes

Tiredness *

Have you felt unusually tired or a sense of general malaise? / ¿Ha sentido dolor muscular o malestar general?

Yes

Conjunctivitis *

Have you had conjunctivitis? / ¿Ha tenido conjuntivitis?

Yes

Diarrhea + *

Have you had diarrhea or other digestive disorders? / ¿Ha tenido vómito o diarrea?

Yes

Rash *

Have you had a rash? / ¿Ha tenido rash o erupción de piel?

Yes

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