FLFA Volunteer Health Check
Covid-19 Health Check
Email address *
Name: *
Date: *
What station did you volunteer at today? (Check all that apply) *
1) Have you experienced a fever of 100.4 degrees For greater in the past 14 days? *
2) Have you received a positive result from a Covid-19 test within the past 14 days? *
3. Have you been in contact with anyone while they had Covid-19 or symptoms of Covid-19 in the past 14 days? *
4. In the past 14 days, have you, or someone you have been in contact with, traveled outside your state/province/country or to an area with restrictions due to Covid-19? *
5. In the past 14 days, have you experienced any of the following new symptoms not attributed to another health condition? Select all that apply. *
Thank you for your cooperation, understanding, and support! YOU ROCK! GO CUTTERS!!!
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy