Ja'Duke Driving School Health Check Point Assessment
Name *
Temperature *
Today or in the past 24 hours, have you or any household members had any of the following symptoms?
Fever? *
Chills? *
Cough? *
Sore Throat? *
Difficulty Breathing? *
Gastrointestinal Symptoms (diarrhea, nausea, vomiting)? *
Headache? *
New loss of taste/smell? *
New muscle aches? *
In the past 14 days, have you had close contact with a person known to be infected with coronavirus? *
In the past 14 days, have you traveled outside of New England to anywhere besides New Jersey or Hawaii? *
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