COVID-19 Attestation for Students

* YOU MUST READ ALL OF THE FOLLOWING QUESTIONS
Do you have a temperature greater than 100.0 °F (37.8 °C) or chills?
Do you have a new or worsening cough not related to an existing condition?
Do you have new or worsening shortness of breath not related to an existing condition?
Do you have a new or worsening sore throat not related to an existing condition?
Do you have new or worsening congestion or runny nose not related to an existing condition?
Do you have a new or worsening headache not related to an existing condition?
Do you have new or worsening body or muscle aches or soreness not related to an existing condition or over exertion?
Do you have new or worsening fatigue not related to an existing condition?
Do you have new or worsening nausea not related to an existing condition?
Do you have new or worsening vomiting not related to an existing condition?
Do you have new or worsening diarrhea not related to an existing condition?
Do you have new or worsening loss of smell or taste not related to an existing condition?
Have you had close, unprotected contact (within 6 feet for 15 minutes or more without a face mask) with a person who you know is positive for COVID-19 within the past 14 days?

I have a temperature greater than 100.0 °F (37.8 °C) or chills. *

Yes

No

---

I have a new or worsening cough not related to an existing condition. *

Yes

No

---

I have new or worsening shortness of breath not related to an existing condition. *

Yes

No

---

I have a new or worsening sore throat not related to an existing condition.*

Yes

No

---

I have new or worsening congestion or runny nose not related to an existing condition.*

Yes

No

---

I have a new or worsening headache not related to an existing condition. *

Yes

No

---

I have new or worsening body or muscle aches or soreness not related to an existing condition or over exertion.*

Yes

No

---

I have new or worsening fatigue not related to an existing condition. *

Yes

No

---

I have new or worsening nausea not related to an existing condition. *

Yes

No

---

I have new or worsening vomiting not related to an existing condition. *

Yes

No

---

I have new or worsening diarrhea not related to an existing condition. *

Yes

No

---

I have new or worsening loss of smell or taste not related to an existing condition. *

Yes

No

---

I have had close, unprotected contact (within 6 feet for 15 minutes or more without a face mask) with a person who you know is positive for COVID-19 within the past 14 days.*

Yes

No

---

You must enter your contact number: *

Preceptor name (if applicable):

Date of close, unprotected contact: *

CLEARED FOR WORK!

You must click on submit to complete your attestation.