Gannon University - Ruskin Campus Daily Health Questionnaire

Gannon University - Ruskin Campus Daily Health Questionnaire
Name *

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

Area Code Phone Number
What is your 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
- Fatigue
- Muscle or body aches
- Headache
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Diarrhea, vomiting, or nausea
- Rash on skin, or discoloration of fingers or toes
- Red or irritated eyes
- Loss of speech or mobility, or confusion*
- Chest pain*
- Difficulty breathing or shortness of breath*
*These are considered serious symptoms and you should seek immediate medical attention if you have any of these symptoms.
Are you experiencing a sudden, unexplained onset of any of these symptoms? *

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

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
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: