COVID-19 Wellness Screening

You have been cleared to come to campus.

Please print or screenshot this page to present when you arrive.

You have indicated that you have been experiencing symptoms related to COVID-19 or have been exposed to a confirmed or suspected case.

Please do the following:

In order to keep the Ram Fam healthy, please do not come to campus.
Look for emergency warning signs* of COVID-19.

If you are showing any of these signs, seek emergency medical care immediately.
- Trouble breathing
- Persistent pain or pressure in the chest
- New confusion
- Inability to wake or stay awake
- Bluish lips or face
*This list is not all possible symptoms. Please call your medical provider for any other symptoms that are severe or concerning to you.

Call 911 or call ahead to your local emergency facility: Notify the operator that you are seeking care as you have displayed symptoms associated with COVID-19.
Contact a healthcare provider

If you do not have the emergency warning signs, contact a healthcare provider for guidance on additional COVID-19 testing or appropriate healthcare options.
Follow your healthcare provider’s recommendations
Rest and take care

If you are sick, please stay at home.

Name

First Name

Please provide your first name.

Last Name

Please provide your last name.

As a convenience, you can fill out one wellness form for all members of your household visiting campus with you. Simply add additional names below.

In the last 3 days, have you or any of the people listed above had fever of at least 100 degrees F or chills?

Yes

Please answer yes or no.

In the past 24 hours, have you or any of the people listed above had any of the following symptoms appear?
Check all that apply.

Fatigue

Cough

Shortness of breath or difficulty breathing

Whole body muscle aches

New or worsening headache

New loss of taste or smell

Sore Throat

Congestion or runny nose

Nausea or vomiting

Diarrhea

In the last 5 days, have you or any of the people listed above been in known close contact with a person who is lab confirmed to have COVID-19?

Yes

Please answer yes or no.

Are you or any of the people listed above being quarantined or living with anyone who has tested positive and is in isolation for COVID-19?

Yes

Please answer yes or no.

I have reviewed the Ram Family Protection Standards and the ASU COVID-19 Notice, and I agree to abide by them.

Please review and agree.

I certify that the information I am providing is true and correct.

Please certify the information entered is true.