COVID-19 Health Screening Questionnaire
for Event Attendees
Full Name
Email Address
Phone Number
Event Date
1. Are you experiencing any of the following symptoms?
Yes
No
2. Have you tested positive for COVID-19 in the past 14 days?
Yes
No
3. Have you had close contact with someone confirmed or suspected of having COVID-19 in the past 14 days?
Yes
No
4. Have you traveled internationally in the past 14 days?
Yes
No
Additional Comments