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Pass/Fail Screening
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Maximum of 9 characters allowed. Currently Entered: 3 characters.
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Visit Information
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Vaccination Assessment
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Have you been fully vaccinated against COVID-19? *
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Symptom & Exposure Assessment
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In the last 15 days, have you experienced mild to severe respiratory illness with any symptoms of fever, cough, and/or shortness of breath? *
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In the last 15 days, have you had a presumed or confirmed contact with anyone diagnosed with Coronavirus? *
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In the last 15 days, have you sought medical care for either of the above scenarios? *
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If you have experienced either of the scenarios above (in the last 15 days), have you come in contact with classmates, coworkers, or other members of the IVC campus community? *
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Acknowledgements *
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IVC Staff Only
This would only be filled out in certain situations so you may ignore it unless you are asked to fill it in.
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