Covid-19 Health and Safety Questionnaire

COVID-19 Safety Questionnaire

Participants First & Last Name(Required)
MM slash DD slash YYYY
Are you fully vaccinated for Covid-19?(Required)
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)
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 • Diarrhea
To the best of my knowledge, within the past 14 days, I HAVE NOT been in close contact with anyone who has tested positive for Covid-19(Required)