Daily Covid Survey

Please complete the form below. Required fields marked with an asterisk *

FIRST Name: Student/Employee/Visitor First Name *

Answer Required

LAST Name: Student/Employee/Visitor Last Name *

Answer Required

Contact Phone Number*

Number Required

I have taken a self administered temperature check today *

Answer Required

Yes

My self administered temperature was below 100.4*

Answer Required

Yes

N/A

Before you enter campus each day, ask yourself if you are experiencing any of the following symptoms you cannot attribute to another condition:

Cough, Congestion, Sore Throat, and/or Runny Nose*

Answer Required

Yes

Shortness of breath/difficulty breathing*

Answer Required

Yes

Fever and/or Chills*

Answer Required

Yes

Fatigue and/or Headache*

Answer Required

Yes

Muscle or Body Aches*

Answer Required

Yes

Nausea, Vomiting, and/or Diarrhea*

Answer Required

Yes

New loss of Taste and/or Smell*

Answer Required

Yes

If you answered YES to any of the symptom questions, please do not enter campus. You will be contacted by a MCP staff member shortly. Thank you for completing this daily Covid Survey.

Please fix the highlighted areas below before submitting.

Daily Covid Survey