Covid Screening Form

Enter your name and answer the questions using the form below.

When complete you will be shown a screen to present to the screeners when you arrive for your shift.
NOTE: This form must be completed prior to each shift.

Fever, sore throat, difficulty swallowing, runny nose, chills, headache (without known cause), nasal congestion (without known cause), new onset of cough, worsening chronic cough, difficulty breathing, unexplained fatigue, muscle aches, diarrhea, abdominal pain, nausea, vomiting, pink eye (conjunctivitis) or decreased/loss of smell / taste.