Genspace Covid-19 Health Screening
Sign in to Google to save your progress. Learn more
Email *
Full Name *
Have you presented proof of vaccination to staff? *
What are the hours you expect to be in the lab today?(ex. 7am-10am) *
Are you exhibiting any symptoms associated with COVID-19 (fever of 100.4 F, shortness of breath , cough, muscle aches, nausea) ? *
In the past 14 days,have you gotten a positive result from a COVID-19 test that tested saliva or used a nose or throat swab? (not a blood test) *
In the past 14 days, have you been in close contact (within 6 feet for at least 10 minutes) with anyone who either tested positive for COVID-19 (not a blood test) or developed symptoms of COVID-19 (fever, cough, or shortness of breath)? *
If you have had COVID-19 within the past 15 days, a negative PCR test is required before coming to Genspace. Please show Genspace staff your proof of negative PCR test. *
Rapid tests and minimum required quarantine are not accepted without a negative PCR test.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Genspace. Report Abuse
Google Forms