1. In the past 48 hours have you had any of the following symptoms:(STAY HOME IF YOU HAVE ANY OF THESE SYPMTOMS)
□ Fever 100.5 F (38C) or above or possible fever symptoms with shivering and sweating
□ New Cough that you cannot attribute to another health condition
□ New Shortness of breath that you cannot attribute to another health condition
□ Flu like symptoms that you cannot attribute to another health condition
□ New body aches/pains with fatigue that you cannot attribute to another health condition
□ New Diarrhea that you cannot attribute to another health condition
□ Loss of smell and taste

2. Have you traveled internationally or domestically in the past 14 days? 
□ YES (I’m UNVACCINATED self quarantine for 14 days without any COVID-19 symptoms)
□ YES (I’M VACCINATED followed CDC guidance without any COVID-19 symptoms)

3. Have you been diagnosed and/or had any close contact with anyone diagnosed with COVID-19 within the last 14 day
□ YES (Stay Home PAST 14 days without Symptoms)