Covid-19 Health and Safety Questionnaire Posted on December 15, 2021December 16, 2021 by Connor McKinney COVID-19 Safety Questionnaire Participants First & Last Name(Required) First Last Today's Date(Required) MM slash DD slash YYYY Phone Number (for contact tracing purposes)(Required)Email (for contact tracing purposes)(Required) Are you fully vaccinated for Covid-19?(Required) YES, I am fully vaccinated No, I am not fully vaccinated If you are NOT fully vaccinated against Covid-19, you may not attend in-person Temple events. Are you experiencing any covid-19 symptoms?(Required) YES, I am experiencing Covid-19 symptoms NO, I am NOT experiencing Covid-19 symptoms Symptoms may include: Fever or chills • Cough • Shortness of breath or difficulty breathing • Fatigue • Muscle or body aches • Headache • Recent loss of taste or smell • Sore throat • Congestion • Nausea or vomiting • DiarrheaTo the best of my knowledge, within the past 10 days, I HAVE NOT been in close contact with anyone who has tested positive for Covid-19(Required) YES, I have been in close contact NO, I have not been in close contact with anyone displaying Covid-19 symptoms Δ
