Open Works COVID-19 Facility Entry Form
In an effort to reduce the risk of COVID-19 exposure to Open Works employees and members during the winter season, all visitors must respond to the following screening questions.

We are all depending on your honesty and integrity when responding to these questions. Each of us has a responsibility to avoid knowingly increasing the chances of passing illness onto someone else. If you need additional information, or assistance in locating a testing facility, go to: www.coronavirus.baltimorecity.gov/testing.

Employees or members answering yes
to any of questions 5-10 or refusing to take the survey will not be permitted access to Open Works' facility.
First Name *
Last Name *
Phone Number *
Community Category (answer in accordance with what you are here for today) *
I have traveled or been in close contact with someone who has traveled outside of the State of Maryland/District of Columbia and/or the U.S. within the last 14 days. *
I have had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days. *
I have experienced cold or flu-like symptoms in the last 14 days (fever, cough, shortness of breath or other respiratory problem). *
I have had a Covid-19 test and received a positive result in the last 14 days. *
I certify my above answers are true. *
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