SOTA Safety
Please fill out a new form each time you are present at STJNUMC.
Email address *
First Name *
Last Name *
Class *
Have you had a fever (100.4 or above) in the past 48 hours? *
Have you experienced a feeling of feverish chills in the past 48 hours? *
Do you have a Cough? *
Do you have a Sore Throat? *
Have you experienced shortness of breath in the past 48 hours? *
Have you experienced sudden loss of taste or smell? *
Have you experienced vomiting or diarrhea in the past 48 hours? *
In the past 14 days, have you traveled to any location for which our State currently requires a 14-day self-quarantine? *
Have you had any close contact with anyone who is currently sick with suspected or confirmed COVID-19? (Close contact is defined as within 6 feet for more than 10 consecutive minutes, without Personal Protective Equipment.) *
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