MHSB COVID Questionnaire Mulligan's Hollow COVID-19 Questionnaire This form is to be filled out entirely to the best of your knowledge. Check the box that applies to you:* Employee Lesson Student Name:* Do you have a fever or chills?* Yes No Are you currently suffering from any of the following symptoms: cough, shortness of breath, sore throat, new loss of smell or taste, and/or gastrointestinal problems, including nausea, diarrhea, and vomiting?* Yes No Do you live with or have you had close contact with someone in the last 14 days who has been diagnosed with, or is displaying the symptoms of, COVID-19?* Yes No Have you traveled via airplane internationally or domestically in the last 14 days? Yes No CommentsThis field is for validation purposes and should be left unchanged. Δ
