MECC COVID-19 Screening
Please answer the following questions honestly. If you answer 'Yes' to any of the screening
questions, please remain outside the building and notify your instructor and/or supervisor by
phone or email and await further instruction.
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to save your progress.
Please enter today's date. (NOT YOUR BIRTHDAY)
What is your name (First and Last) ?
For what purpose are you on-campus today?
Class or classes
Do you have any of the following new or worsening symptoms that cannot be attributed to another pre-existing health condition? If yes, check all symptoms that apply. If no, choose N/A.
N/A - No Symptoms
Cough / Shortness of Breath
Runny Nose / Congestion
Loss of taste/smell
Have you been directly exposed to someone being tested for COVID-19 or who has symptoms consistent with COVID-19 (those listed in the previous question), while NOT WEARING appropriate PPE as recommended by the CDC, such as in a healthcare setting?
Are you currently waiting on the results of a COVID-19 test due to a possible exposure or being personally symptomatic? (Choose only one.)
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This form was created inside of Virginia's Community Colleges.