COVID 19 SCREENING TOOL-Have you had any of the following symptoms in the last 3 days?

If you answer YES to any of the questions below you MAY NOT enter the building.
Email address *
your name
todays date
MM
/
DD
/
YYYY
building you are entering
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COUGH
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FEVER
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SHORTNESS OF BREATH/ DIFFICULTY BREATHING
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CHILLS/ MUSCLE or BODY ACHES
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CONGESTION OR RUNNY NOSE
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SORE THROAT
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DIARRHEA
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NAUSEA OR VOMITTING
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LOSS OF SMELL or TASTE
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HEADACHE
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