PT Department COVID-19 Symptoms Assessment Screen

Emory & Henry College SHS/SON COVID-19 Symptom Screening

All fields marked with asterisk (*) are required.

required date/time field
Date & Time of Screening*
at
required e-mail address field
required text field
required text field
required text field
Please include area code
required radio button field
Please select from the following options, I am a:*
header field

Symptom Screen

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Please check the boxes for all symptoms that apply. If you have no symptoms, please check "N/A- I do NOT have any symptoms." If you have symptoms, please remain at home until you have been contacted by a COVID Team member to await further instructions. If you have NO symptoms, you may come to campus and MUST wear your mask until protocol is met (at minimum 5 days). This is fluid and can change. Please contact your department with any questions.

required checkbox field
In the last 48 hours have you had or do you currently have any of the following? (check all that apply)*
If you have no symptoms, please check N/A- I do NOT have any symptoms.