Daily Wellness Check
Question 1 of 6
What is your location code?
Location Code
Please enter a valid location code
Your location contact will provide your location code.
Question 2 of 6
Within the past 14 days, have you or any member of your family had any of the following symptoms?
Abnormally pale skin, chills, congestion, cough, diarrhea, fatigue, fever, headache, mild pink eye, muscle pain or body aches, new loss of taste or smell, runny nose, shortness of breath, sore throat, unusual sweating, vomiting or nausea
Yes, one or more of the above
No, none of the above
Please select an answer
Question 3 of 6
Within the past 14 days, have you had close contact with anyone suspected of contracting or having COVID-19?
Yes
No
Please select an answer
Question 4 of 6
Within the past 14 days, have you had a positive COVID-19 test?
Yes
No
Please select an answer
Question 5 of 6
Within the past 14 days, have you been in contact with anyone who has traveled to the U.S. from overseas?
Yes
No
Please select an answer
Question 6 of 6
What is your email address?
Email Address
(optional)
Please enter a valid email address
If you choose to enter your email address, we will send you a link to a second entry code for access from other devices at your convenience. Your email address will not be saved or shared.
By clicking "Submit Responses", you declare that you have answered all questions truthfully.
Submit Responses
Please complete all required fields
There was an unexpected error. Please review your responses and try again.
