OLL COVID-19 HEALTH SCREEN ATTESTATION:

OLL COVID-19 HEALTH SCREEN ATTESTATION:

To be conducted daily before access to OLL facilities.
Person's name coming on campus *

First Name Last Name
Date *

Month Day Year
Date
Role at OLL *

Student Staff Other
Symptoms of Covid-19
- Cough
- Fever (above 100.04 ) or chills (before taking any medication to reduce the fever)
- Shortness of breath or difficulty breathing
- Unusual Fatigue
- Muscle or body aches
- Headache
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea or vomiting
- Diarrhea
Within the past 14 days, have you had close contact with anyone that you know who had COVID-19 or COVID-19 like symptoms? Close contact is defined as being within 6 feet for more than 15 minutes with a person, or having direct contact with fluids from a person with COVID-19 (for example, being coughed or sneezed on), or the person lives in your household.

Have you had a positive COVID-19 test for active virus in the past 10 days?

Within the past 14 days, has a public health or medical professional told you to self-monitor, self-isolate, or self-quarantine because of concerns about COVID-19 infection?

Do you have any of the symptoms of COVID-19 above that are not attributable to another condition?
Please answer Yes, if any of the above are true or No, if none are true. *

Yes No
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