End of Year Celebration 2021 Health Screening
Family Name
Family Name:
Have you or anyone in your household tested positive for Covid-19 in the past 2 weeks or have pending results from a Covid-19 test?¿Usted o alguien de su hogar ha dado positivo en Covid-19 o estás esperando los resultados de una prueba de Covid-19? en las últimas 2 semanas?
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Have you or anyone in your household been exposed to someone who has tested positive for Covid-19 in the last two weeks?¿Usted o alguien de su hogar ha estado expuesto a alguien que ha dado positivo en Covid-19 en las últimas 2 semanas ?
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Does anyone have any of the following symptoms?¿tiene alguno de los siguientes síntomas?
Has everyone in the family passed the temperature check (if over 100.4 they must be sent home)
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Health Screening Completed by:
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