Puna Taiko Health Screening Form
Name *
Phone # *
What is your temperature upon entry? *
If your temperature is above 100 degrees (F), please go to the doctor.
Have you or anyone in your household had any of the following symptoms in the last 14 days: sore throat, cough, chills, body aches for unknown reasons, shortness of breath for unknown reasons, loss of smell, loss of taste, fever at or greater than 100 degrees Fahrenheit? *
If yes, please go home and consider getting tested.
Have you or anyone in your household tested positive for COVID-19 in the last 14 days? *
If yes, please go home. You're welcome back in two weeks.
To the best of your knowledge have you been in close proximity to any individual who tested positive for COVID-19? *
If yes, please go home. You're welcome back in two weeks.
Have you or anyone in your household traveled out of the state in the last 14 days? *
If yes, please go home. You're welcome back after they test negative.
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