Name* First Last Do you have a temperature of 100 degrees or higher?*YesNoHave you or a member of your household had a temperature of 100 degrees or higher within the last 72 hours?*YesNoDo you or a member of your household have symptoms of Coronavirus such as fever, coughing, shortness of breath, loss of taste and smell, or sore throat?*YesNoHave you been exposed to someone with a confirmed case of COVID-19 within the last 14 days?*YesNoHave you traveled anywhere by plane – or – to a state with a positivity rate over 15% in the last 14 days?*(See Link Below for Positivity Rates)YesNohttps://coronavirus.ohio.gov/wps/portal/gov/covid-19/families-and-individuals/COVID-19-Travel-Advisory/COVID-19-Travel-Advisory
