Self Check Certification Online Form: Self Check Certification Student Name* First Last Fever, cough or muscle aches?* Yes No Sore throat, runny nose and/or loss of taste or smell?* Yes No Nausea, vomiting, and/or diarrhea?* Yes No Shortness of breath and/or headache?* Yes No Close contact or cared for someone with COVID-19?* Yes No HiddenSymptoms Calculation (DON'T REMOVE)Your current temperature:*EmailThis field is for validation purposes and should be left unchanged.
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