Covid-19 Symptoms Declaration
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City of studies
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During the last 14 days, have you had one or more of the following symptoms?
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During the last 14 days, did you, or any of your companions have close contact with someone with symptoms?
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During the last 14 days, have you or any of your companions had a diagnostic test for COVID-19 with a positive result?
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During the last 14 days, have you worked or volunteered in a healthcare facility or as a first responder? Healthcare facilities include a hospital, medical or dental clinic, long-term care facility, or nursing home.
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To the best of my ability, I certify answers to the preceding questions are true and correct.