Daily Covid-19 Screening Form 

Please carefully answer each question and if YES to any answer or symptom, contact Paige Ramos at 912/665-2545 or Erin Wieniewitz, RN at 912/659-1509

1. Have you experienced any of the following symptoms of COVID-19 within the last 48 hours?
2. Have you tested positive for COVID-19 in the past 10 days?
3. Have you been diagnosed with COVID-19 by a licensed healthcare provider in the past 10 days?
4. Are you currently awaiting results from a COVID-19 test?
5. Have you been told you are suspected to have COVID-19 by a licensed healthcare provider in the last 10 days?
6. Have you been exposed to anyone that CURRENTLY has ACTIVE COVID-19?

Thanks for submitting!