Facilities COVID-19 Screening
Email address *
What is your name? *
Your company? *
Have you experienced any of the following symptoms in the past 48 hours: *
Required
Within the past 14 days, have you been in close physical contact (6 feet or closer for a cumulative total of 15 minutes) with: *
Required
Are you isolating or quarantining because you may have been exposed to a person with COVID-19 or are worried that you may be sick with COVID-19? *
Do you certify the above answers above to be true? *
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