HEALTH ASSESSMENT FOR VISITING VENDORS TO ROWAN UNIVERSITY
To aid in the monitoring of the health of the Rowan University population, you must submit this screening regarding your wellness before proceeding with your business on our campus. Please complete this form to answer basic questions regarding potential symptoms of COVID-19.
* Required
Your Name
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Your answer
Company Name
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Your answer
Date of Visit
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MM
/
DD
/
YYYY
Your Phone #
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Your answer
Your Email
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Your answer
Do you have a fever of 100.4ºF or greater?
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Yes
No
Do you have any of the following symptoms not associated with existing medical conditions: shortness of breath, new cough, excessive chills, severe muscle pain, loss of taste or smell, or new profound headache?
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Yes
No
Within the past 2 weeks have you traveled to or from a high risk COVID-19 state or country for personal reasons, other than work or school, or have you been exposed to anyone known to be positive for COVID-19? (This excludes healthcare workers exposed while wearing recommended PPE.)
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Yes
No
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