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Visitor
Health Assessment

Last Updated: 4/14/2021

Each vistor has to submit their own assessment.

Answer are recorded and viewable by only our Senior Leadership team. Results will not be revealed publicly

Full Name (No Special characters such as ' , .)
Your Business (No Special characters such as ' , .)
HAVE YOU BEEN FULLY VACCINATED AGAINST COVID-19 AND HAS IT BEEN AT LEAST 2 WEEKS SINCE YOUR LAST DOSE OF COVID-19 VACCINE? *

PLEASE REVIEW EACH OF THE STATEMENTS BELOW:

OVER THE LAST 14 DAYS, I HAVE NOT HAD ANY SYMPTOMS OF SICKNESS; NO COLD SYMPTOMS, NO FLU SYMPTOMS, AND NOT ANY OF THE ONES LISTED HERE:

*Reminder, if you have ANY sickness symptoms, please stay home.*

A FEVER (100.4F OR HIGHER) COUGH SORE THROAT
SHORTNESS OF BREATH CHILLS FATIGUE
LOSS OF TASTE OR SMELL NAUSEA VOMITING
DIARRHEA TROUBLE BREATHING PERSISTENT PAIN IN THE CHEST
CONFUSION BLUISH LIPS OR FACE NEW MUSCLE ACHES
MY CURRENT TEMPERATURE IS WITHIN THE "SAFE RANGE" OF 96.0 to 100.4 DEGREES FAHRENHEIT.
BY CLICKING THIS SUBMIT BUTTON, I AM CONFIRMING THAT I HAVE REVIEWED EVERYTHING HERE AND CAN HONESTLY SAY I AGREE TO ALL THE STATEMENTS. I WILL ONLY ENTER ANY TOWNSEND LEATHER BUILDING FREE OF ANY KNOWN SICKNESS AND WILL DO EVERYTHING I CAN TO KEEP MYSELF AND OTHERS SAFE.
IF I CAN NOT AGREE TO ALL OF THE ABOVE STATEMENTS, I WILL CONNECT WITH MY TOWNSEND CONTACT PERSON TO RESCHEUDLE MY APPOINTMENT.

Last Updated: 4/14/2021