In order to protect your health and the health of our employees and our community at large, we ask that you answer the following questions regarding Covid 19.

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Have you or anyone in your household travelled by air or out of the country in the past 21 days?

To the best of your knowledge, have you or anyone you have been in close proximity with been tested for or confirmed with COVID-19?

Have you or anyone in your household cared for an individual in quarantine for a presumptive positive or confirmed with Covid 19?

Have you or anyone in your household had any of the following symptoms in the last 21 days: sore throat, cough, chills, body aches for unknown reasons, shortness of breath for unknown reasons, loss of smell or taste, fever at or greater than 100 degrees Fahrenheit?

Do you have any reason to believe you or anyone in your household has been exposed to or acquired COVID-19?