wellness true COVID-19 Wellness Screening - Visitors

COVID-19
Visitor Wellness Screening

This screening tool is intended for use by ASU visitors only. ASU students and employees must use the screening tool found in RamPort.

Name
Please provide your first 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?
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.
In the last 3 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?
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?
Please answer yes or no.
Please review and agree.
Please certify the information entered is true.