Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

COVID-19 Self-Screening Form

  1. Do you have a fever greater than 100.4 degrees? *
  2. Do you have any of the following symptoms: fever, cough, shortness of breath, sore throat or diarrhea?*
  3. Do you have any of the following symptoms?
  4. Have you had close contact in the last 14 days with an individual diagnosed with COVID-19 and you are not fully vaccinated?*
  5. Have you traveled internationally in the last 14 days? *
  6. Do you have a face mask or face covering to allow entry into the building?*
  7. Temperature (Court to Process)
  8. Signature (Court to Process)
  9. __________________
  10. _______________________
  11. Leave This Blank:

  12. This field is not part of the form submission.