COVID-19 Health Screening Questionaire

COVID-19 Health Screening Questionnaire

Please complete this quick survey prior to your visit to help everyone stay safe and healthy. The purpose of this screening questionnaire is to minimize workplace transmission of COVID-19 by identifying visitors' potential exposures. All visitors must complete it prior to your visit.

Fields marked with an * are required
Visiting Date *
Do you have a fever? *
Have you tested positive for COVID-19 in the past 10 days? *
Have you traveled in the past 10 days? *
Have you had close contact with or cared for some diagnosed with COVID-10 within the past 14 days? *
Have you experienced any cold or Flu-like symptoms in the past 14 days? (such as fever, cough, shortness of breath, or other respiratory problem) *

If you have answered "No" to all questions, you may proceed with your visit.

If you have answered "Yes" to any of the above questions, you will not be permitted access to BEC's facility and may reschedule your visit.
MonTueWedThuFriSatSun
2829301234567891011121314151617181920212223242526272829303112345678