Health Self-Evaluation Form

Health Self-Evaluation Form

Required

Name *

First

First

Last

Last

What is your temperature? *

Guest Name *

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First

Last

Last

What is their temperature? *

Guest Name

First

First

Last

Last

What is their temperature?

Do you or your guest have any of the following (please check all that apply) *

Have you or your guest been in close contact (within 6’) with someone who has a laboratory confirmed Covid-19 diagnosis within the past 14 days? *

If yes, have you been tested?

Date

Year Month Day

Result

HYPE Day: Briana Scurry

HYPE Day: Briana Scurry

Speaking Across the Divide

Speaking Across the Divide

Faculty Research Symposium

Faculty Research Symposium

Day of Giving

Day of Giving

HYPE Day: Kal Penn

HYPE Day: Kal Penn

HYPE Day: Roxana Saberi

HYPE Day: Roxana Saberi

PALS Dinner and Keynote: Vernice "FlyGirl" Armour

PALS Dinner and Keynote: Vernice "FlyGirl" Armour

Heathers: The Musical

Heathers: The Musical

Heathers: The Musical

Heathers: The Musical

Heathers: The Musical

Heathers: The Musical

Heathers: The Musical

Heathers: The Musical

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