Gannon Daily Health Questionnaire

Gannon Daily Health Questionnaire
Name *

First (Given) Name Last Name (Surname)
Risk
Gannon Email Address *
(This sends the results to your email, enabling documentation.)
Phone Number *

Area Code Phone Number
Affiliation *
According to the U.S. Centers for Disease Control and Prevention & the World Health Organization, COVID-19 Symptoms include:
- Fever (100.4 or higher) or Chills
- Cough
- Shortness of breath or difficulty breathing
- Fatigue
- Muscle or body aches
- Headache
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Diarrhea, vomiting, or nausea
Are you experiencing a sudden, unexplained onset of any of these symptoms? *

Yes No
Since last completing this survey, have you been exposed to anyone who is known or suspected to have COVID-19 (other than in a clinical setting when dressed in full PPE — N95 mask, gown, face shield/goggles, and gloves) *

Yes No
Have you tested positive for COVID-19 since the last time you completed this survey? *

Yes No
Have you traveled via airline or outside the State of Pennsylvania for non-routine commuting reasons since the last time you completed this survey? *

Yes No
If you have any questions or concerns, please contact the Campus Health Center at (814) 871-7622.
Date

Year Month Day
Date Hour Minutes AM/PM Option
I certify all the information provided is shared to the best of my ability.
Should be Empty: