Centralia College Sign In Form
Please complete this form to check in when you are in a campus building. It is REQUIRED that all staff, faculty, students, visitors and vendor/contractors check in when they are on campus.

Visitors & Vendor/Contractor must check-in at the Facilities (FOM) Office at 415 W Pear St.
 
If you have any questions, please call 360-623-8741 (x.8741) or email covid19@centralia.edu.

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Email *
First & Last Name *
Occupying which Buildings (&/or Rooms) *
24/7 Personal Phone (Home or Cell) *
Format: ###-###-####
Date & Time You Arrived? *
MM
/
DD
/
YYYY
Time
:
What time do you plan to leave? *
Time
:
By clicking submit, you are attesting that you have not experienced any of the following symptoms within the last 72 hours:
* Fevers or feeling feverish
* Chills and/or repeated shaking with chills
* Cough
* Shortness of Breath
* Muscle or Body Aches
* Headaches
* Fatigue (tiredness)
* Loss of taste or smell
A copy of your responses will be emailed to the address you provided.
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