Health Screening Survey
I am a(n):
What is your first and last name?
Check if you have any of the following symptoms:
Fever of 100.4 degrees of higher (as measured by touchless thermometer if available, but a verbal confirmation of lack of fever is sufficient if a touchless thermometer is not available).
Cough (excluding chronic cough due to a known medical reason other than COVID-19).
Shortness of breath.
Diarrhea (excluding diarrhea due to a known medical reason other than COVID-19.
I have none of the above.
Have you traveled internationally or outside the state of MI in the last 14 days, excluding commuting from a home location outside of MI? For purposes of this order, commuting is defined as traveling between one's home and work on a regular basis.
Have you had any close contact in the last 14 days with someone that was diagnosed with COVID-19?
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