COVID-19 Assessment Form – For Employees & Visitor Tours ONLY

Visitor Type*

Primary Visitor

Name

First Last

Email*

Cell Phone*

Additional Visitors

Name

First Last

Name

First Last

Name

First Last

Name

First Last

Assessment Protocol

Have you or any of your additional visitors had any of the following symptoms in the last 72 hours (not related to hay fever or seasonal allergies)? [Please check all that apply]*

In the last 7 days, have you or any of your additional visitors been in contact with someone that has COVID-19?*

In the last 14 days, have you or any of your additional visitors been diagnosed with COVID-19?*

Signature*

By checking this box and typing my name below, I am electronically signing this COVID-19 Assessment Form and I agree to and attest to the following: 1. The above answers are true and correct to the best of my knowledge. 2. I/WE will abide by all campus rules regarding the wearing of a face covering, adhering to physical distancing, and area hygiene. 3. Failure to abide by campus rules could result in not being allowed to access the facility; or if inside the facility, being asked to leave the building immediately.

Date*

COVID-19 Assessment Form - For Staff & Tour Visitors

COVID-19 Staff & Tour Visitor Assessment Form

Primary Visitor

Additional Visitors

Assessment Protocol

COVID-19 Staff & Tour Visitor Assessment Form

Primary Visitor

Additional Visitors

Assessment Protocol

COVID-19 Assessment Form - For Staff & Tour Visitors

COVID-19 Staff & Tour Visitor Assessment Form

Primary Visitor

Additional Visitors

Assessment Protocol

COVID-19 Staff & Tour Visitor Assessment Form

Primary Visitor

Additional Visitors

Assessment Protocol

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