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Centennial UMC Daily Staff Screening
(Required only for staff expecting to be on site today)

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* 1. Please Select Your Name

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* 2. Which campus will you be visiting

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* 3. Approximately what time will you be arriving?

Time

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* 4. What time do you expect to leave?

Time

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* 5. Have you today or in the last 10 days been diagnosed with COVID-19

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* 6. Have you today or in the last 10 days have a fever or felt feverish?

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* 7. Have you today or in the last 10 days have/had the chills?

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* 8. Have you today or in the last 10 days developed a cough?

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* 9. Have you today or in the last 10 days experienced shortness of breath?

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* 10. Have you today or in the last 10 days developed  a sore throat?

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* 11. Have you in the last 10 days or now developed new muscle aches?

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* 12. Have you today or the last 10 days developed a headache?

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* 13. Have you today or in the last 10 days lost your sense of taste or sense of smell?

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* 14. Do you agree to inform Centennial United Methodist Church immediately if you develop any of the above symptoms or receive a positive COVID-19 diagnosis?

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