VOLUNTEER COVID-19 SURVEY

JEEP BEACH COVID-19 SELF-SCREENING
PLEASE READ EACH QUESTION CAREFULLY AND ANSWER THE FOLLOWING QUESTIONS.

Have you experienced any of the following in the past 48 hours?

Within the past 14 days, have you been in close physical contact (6 feet or closer for a cumulative total of 15 minutes) with anyone who is known to have laboratory-confirmed COVID-19?

Within the past 14 days, have you been in close physical contact (6 feet or closer for a cumulative total of 15 minutes) with anyone who has any symptoms consistent with COVID-19?

Are you isolating or quarantining because you may have been exposed to a person with COVID-19 or are worried that you may be sick with COVID-19?

Are you currently waiting on the results of a COVID-19 test?

Which COVID-19 vaccination have you received?