COVID-19 Health Screening WWSA
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Email *
First Name *
Last Name *
Have you knowingly been in close contact (within 6 ft, for more than 10 consecutive minutes without preventative measures) in the past 10 days with someone diagnosed with or suspected of having COVID-19? *
Have you tested positive for COVID-19 in the past 10 days? *
Have you experienced any of the following symptoms in the last 24 hours that are new or not usual symptoms for you? Fever, Chills, Cough Shortness of breath, Fatigue, Muscle or body aches, New loss of taste and/or smell, Sore throat, Vomiting/Diarrhea *
Have you experiences a temperature equal or greater than 100.0F, in the last 24 hours? *
Within the last 10 days have you been asked to quarantine by the department of health? *
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