Prevent COVID-19

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Prevent COVID-19

Please fill out this brief health screening questionnaire in advance of the event you are attending (may be done beforehand or when you arrive but please complete it on the day of the event). If you have not tested for Covid within four days of the event please see security for a complimentary rapid test kit and then return to complete this form. A space will be provided at Calico reception for those needing to take a rapid test upon arrival.

COVID-19 Screening Questionnaire

All individuals entering the building must fill out the questionnaire and follow the corresponding guidance. Note that masks are optional.

First name *

Last name *

Name of the event you are attending *

Please initial acknowledging that you have tested negative for COVID-19 within the last four (4) days. *

Do you have any of the following symptoms?
*

Fever or Chills, Cough, Shortness of Breath, Congestion or Runny Nose, Fatigue, Muscle or body aches, Headache, Sore Throat, Loss of Taste or Smell, or Diarrhea

Yes - If the answer is YES, please do not enter the building.

No - If the answer is NO, proceed to the next set of questions.

Do you have a reason to suspect you’ve been exposed to COVID-19 over the past 72 hours?
*

Yes - If the answer is YES, you may come onsite if you are both asymptomatic and you have a negative COVID-19 test.

No - If NO, come onsite to work.

Other:

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