COVID-19 Screening Form

Select the appropriate category for your relationship to Northeast College of Health Sciences, below:

Student

Employee or visitor

First Name

Last Name

1. HAVE YOU BEEN EXPOSED TO SOMEONE WITH A CONFIRMED CASE OF COVID-19?

Yes

2. ARE YOU EXPERIENCING SYMPTOMS CONSISTENT WITH COVID-19?

Yes

3.HAVE YOU RECENTLY TESTED POSITIVE FOR COVID-19?

Yes