Health Screening | Cooling Equipment Service

Name *

First

Last

Email *

Are you experiencing any of the following symptoms not caused by another condition: Fever or chills · Cough · Shortness of breath or difficulty breathing · Fatigue · Muscle or body aches · Headache · New loss of taste or smell · Congestion or runny nose · Nausea or vomiting · Diarrhea *

Yes
No

Have you been in contact with anyone who has COVID-19 or has COVID-like symptoms within the past 14 days? *

Yes
No

Health Screening Checklist