Covid-19 Health Screening Log
Crosswinds Aviation COVID-19 Health Screening Log
Sign in to Google to save your progress. Learn more
First and Last Name *
Body temperature at or above 100.4 degrees F? *
Have a cough? *
Have shortness of breath? *
Have a Sore Throat? *
Have Diarrhea? *
Have Chills *
Have New Loss of Taste or Smell? *
In the Last 14 days have you knowingly had close contact with someone with a positive diagnosis of Covid-19? *
In the last 14 days have you traveled via airplane internationally? *
Agreement to Release of Liability
By submitting this form, you are agreeing to MIDWEST AIR LLC D/B/A CROSSWINDS AVIATION – RELEASE OF LIABILITY AND INDEMNITY AGREEMENT found here: https://www.crosswindsaviation.com/release/
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Crosswinds Aviation.

Does this form look suspicious? Report

Google Forms