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Minutes
AM
PM
AM/PM Option
KEC Staff COVID Questionnaire
Name
Dr. Chen
Dr. Baum
Dr. Watase
Margarita
Grace
Angel
Kristen
Jo-Zann
Portia
Jeann
Elyse
Rachel
Julene
Other
Name
Have you met anyone outside of your household without wearing a mask, eating or drinking, no matter the distance, indoors or outdoors since yesterday?
No
Yes
Have you been in close contact with anyone that tested POSITIVE for COVID?
No
Yes
Have you been wearing a mask outside of work?
No
Yes
Do you feel sick?
No
Yes
Have you had any of these symptoms since yesterday?
No
Yes
Lack of Energy
Fever
Chills
Sore Throat
Cough
Diarrhea
Sinus Congestion
Runny Nose
Body Aches
Difficulty Breathing
Loss of Taste
Loss of Smell
Pink Eye or Itchy Eye
Submit
Should be Empty: