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COVID Check Form

COVID-19 Check In Form

Name *

Position *

Travel Destination *

Reason for travel *

Do you have any of the following COVID-19 symptoms: *

Fever of 100.4 or greater

Symptoms of respiratory illness (nasal drainage, congestion, cough or shortness of breath)

New loss of taste or smell

Diarrhea more frequent than normal

Chills

Fatigue

Muscle or body aches

Headache

Sore Throat

Nausea or Vomiting

Positive COVID test in the past 10 days

None of the Above

If you are human, leave this field blank.

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