Lindsey Wilson College
Secure Network
Please answer the following questions related to COVID-19 and your visit to campus.
Name:
Date scheduled to arrive on campus:
In the last 24 hours have you had a fever (100.5°F or higher)?
Yes
No
Are you currently experiencing or have you had two (2) or more of the following symptoms (unrelated to seasonal allergies) in the last 24 hours?
A new cough
Shortness of breath
Difficulty breathing
Sore throat
New muscle aches or headache
Gastrointestinal symptoms (i.e. diarrhea, vomiting, etc.)
Chills or repeated shaking with chills
A new loss of taste or smell
Fatigue
Congestion or runny nose
Yes
No
Have you been in close contact (within 6 feet in an enclosed space for more than 15 minutes, regardless of whether or not you're wearing a mask) with anyone who has been diagnosed with COVID-19 in the last 48 hours?
Yes
No
I understand that Lindsey Wilson College is taking the necessary steps to comply with CDC stipulations to address COVID-19 safety. I agree to comply with their requests of me while on campus for my safety and the safety of others.
