COVID-19 Health-Screening Form

Select the appropriate category for your relationship to Northeast College of Health Sciences, below:
1. In the last 14 days, have you experienced any symptoms of COVID-19? Including:
  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea
  • Headache
  • Sore throat
  • New loss of taste or smell
2. Have you recently tested positive for COVID-19?
3.In the last 14 days, have you knowingly had new/previously unreported close or proximate contact with anyone who has tested positive for covid-19 or who has had symptoms of covid-19? *note, only answer "yes" to report new possible exposures; otherwise select "no".