COVID-19 Health Screening Form
NWRTC -
Instructor Names
Other Student
Other Instructor
Temperature in Degrees F ? *
Fever of 100 degrees F or > *
Do you have a cough, shortness of Breath or difficulty breathing, sore throat, muscle pain, and/or new loss of taste or smell? *
Do you have a pending COVID-19 Test? *
Have you traveled internationally or outside Michigan in the last 14 Days *
Does anyone in your house have a fever of 100.4 or higher or have any other COVID-19 symptoms? *
Have you had contact with another person diagnosed with COVID-19 in the last 14 days or has pending test results?(if yes, if proper PPE was worn, your answer should be NO) *
If you answered yes to any of these questions, please contact Chief Bill Parker 231-735-2376, prior to entry into the RTC.
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