Camp West Woods - Staff Daily Self-Health Check
Please complete this form every morning (Monday to Friday) when you are working at camp. This is required by state / board of health. The form MUST be completed by 7:30 AM each day. If the form is not completed by 7:30 AM, you will be denied access to the camp facility.
Please enter your full name
Today or in the past 24 hours, have you or any household members had any of the following symptoms?
Fever (temperature of 100.0F or above), felt feverish, or had chills ?
Sore throat ?
Difficulty breathing ?
Gastrointestinal symptoms (diarrhea, nausea, vomiting)?
New loss of smell/taste?
New muscle aches?
Any other signs of illness?
Staff and all family members are healthy
In the past 14 days, have you had close contact with a person known to be infected with the novel coronavirus (COVID-19)? Close contact is defined as being within 6 feet of an individual who has tested positive for COVID-19 for more than 10 minutes while that person was symptomatic, starting 48 hours before their symptoms began until their isolation period ends.
Send me a copy of my responses.
Never submit passwords through Google Forms.
This form was created inside of National Camp West Woods Inc.