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COVID-19 Screening Checklist
Please fill out within 2 hours prior to each visit to i3Detroit
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* Indicates required question
Your name:
*
Your answer
Your phone number:
*
Your answer
Do you have a fever, or is your temperature above 100.4° F or 38C (using a thermometer if possible)?
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Yes
No
Do you have a cough (excluding chronic cough due to a known medical reason other than COVID-19)?
*
Yes
No
Do you have shortness of breath?
*
Yes
No
Do you have at least two of the following symptoms: chills, repeated shaking with chills, muscle pain, headache, sore throat, new loss of taste or smell, and/or diarrhea (excluding diarrhea due to known medical reason), and extreme fatigue?
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Yes
No
Have you traveled internationally within the last 14 days?
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Yes
No
Have you had close contact with a confirmed COVID-19 case in the past 14 days?
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Yes
No
I have checked for any updates to the COVID-19 Rules and Best practices since my last visit, via the i3-announce mailing list and the i3 Wiki, and fully understand the rules in their current state
*
I agree.
Required
If you answered NO to the above six questions and checked the box that says "I agree", you have passed the screening and may enter i3Detroit. If you answered YES to any of the questions, you have failed the screening and you may not enter i3Detroit.
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