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.

Entry Screening Questionnaire

  1. Notice
    Do not include any sensitive information on this form or (if applicable) files uploaded to this form. Sensitive information includes, but is not limited to, social security numbers, driver’s license numbers, bank account information, routing numbers, medical information, passport numbers, or passwords.
  2. Entry Screening Questionnaire
  3. Do you have any of the following symptoms?
    Fever greater than 100F, Severe cough, Shortness of breath, Muscle aches, Chills, Sore throat, Runny nose or congestion, Nausea or diarrhea, New loss of taste or smell
  4. If you answer "YES" to any of the above symptoms:
    -You will NOT be permitted access to County facilities. Please self-isolate at home and contact your primary care physician if you need medical assistance.
  5. -If you are a County employee, inform your supervisor immediately, and then contact your primary care physician.
  6. If you answer "NO" to any of the above symptoms:
    -Agree to having your temperature taken upon request
  7. -Agree to wear a face covering at all times while in any spaces designated as "Enclosed Public Space"
  8. -Agree to maintain social distancing
  9. Then you may enter this County facility.
  10. Confirmation*
  11. Leave This Blank: