Diamond Heroes Covid-19 Screening
Please print out, complete, and turn in when arriving at the facility. If you have answered yes to any of the following questions, please remain home or leave the premises.
First and Last name
Date
MM
/
DD
/
YYYY
Have you had any of the following symptoms? *
Required
What was your temperature before arriving to the facility? *
Have you been in contact with someone who has been diagnosed with COVID-19? *
Do you live or visit a place where there has been a Covid-19 case? *
Are any members of your household a close contact on quarantine for exposure to COVID-19? *
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