SCCRESA COVID-19 Self-Assessment
Please complete the following COVID-19 screener. Please do NOT enter the building if you answer yes to ANY of the questions. Please call 810.364.8990 with any questions.
Name *
Cell phone/Contact Phone Number *
Company/Organization
Reason for Visit *
COVID-19 Symptoms
Do you have any of the following symptoms/conditions?
Dry cough *
1 point
Difficulty breathing *
1 point
Fever of 100.4 or higher *
1 point
Sore throat *
1 point
Sudden loss of taste or smell *
1 point
Been in contact with someone who tested positive for COVID-19 *
Tested positive for COVID-19 within the last fourteen days *
Submit
Never submit passwords through Google Forms.
This form was created inside of St. Clair County RESA. Report Abuse