COVID-19 Status Report

COVID-19 Status Report

Please check all symptoms and indicate who has exhibited them and when.

Fever (temperature of 100.0 F or above), felt feverish, or had chills
Sore throat
Shortness of breath or difficulty breathing
Gastrointestinal symptoms (diarrhea, nausea, vomiting)
New loss of smell/taste
New muscle aches
Runny nose or congestion
Other symptoms - please explain

Potential exposure: *

Thank you for submitting this information.

We will report relevant information to our governing agencies and will be in contact regarding next steps.
I hereby certify that the responses provided above are true and accurate to the best of my knowledge.