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OT Department COVID-19 Symptoms Assessment Screen

Emory & Henry College SHS/SON COVID-19 Symptom Screening

All fields marked with asterisk (*) are required.

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Date & Time of Screening*
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Please include area code
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Please select from the following options, I am a:*
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Symptom Screen

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Please check the boxes for all symptoms that apply. If you have no symptoms, please check "N/A- I do NOT have any symptoms." If you have symptoms, please remain at home until you have been contacted by a COVID Team member to await further instructions. If you have NO symptoms, you may come to campus and MUST wear your mask until protocol is met (at minimum 5 days). This is fluid and can change. Please contact your department with any questions.

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In the last 48 hours have you had or do you currently have any of the following? (check all that apply)*
If you have no symptoms, please check N/A- I do NOT have any symptoms.