Exit MNS Meeting Sign-In Question Title * 1. Your name (First and Last) Question Title * 2. Credentials Question Title * 3. Attending In Person or Virtually (please check one) In Person (Maple Hill Farm, Hallowell, Maine) Virtual Note: Health Questions (#'s 4-10) for in-person only. If participating skip to question #11. Question Title * 4. Have you tested positive for COVID-19 in the last 24 hours? No Yes Question Title * 5. Are you experiencing a sore throat, cough, chills, or body aches? No Yes Question Title * 6. Are you experiencing a new loss of taste or smell? No Yes Question Title * 7. Are you experiencing nausea, vomiting or diarrhea? No Yes Question Title * 8. Are you experiencing a shortness of breath for unknown reasons? No Yes Question Title * 9. Do you have any reason to believe that you, or anyone you've been in close contact with over the last 24 hours, has been exposed to or acquired COVID-19? No Yes Question Title * 10. The CDC recommends that if you have had any of the above symptoms in the last 48 hours, you DO NOT physically return to the workplace (i.e. the conference rooms) until symptoms have been improving for more than 48 hours. I understand. Question Title * 11. Comments / Questions / Suggestions(NOTE: this may not be checked for several hours.) Thank You - Enjoy the meeting! Submit to Sign In
