COVID Screening

In order to protect the health of GVH employees and staff, we ask that you self-screen for symptoms or other risk factors of COVID-19 using this form.


1. Have you experienced any of the following symptoms in the past 48 hours:

fever or chillscoughshortness of breath or difficulty breathingfatiguemuscle or body achesheadachenew loss of taste or smellsore throatcongestion or runny nosenausea or vomitingdiarrhea

2. Within the past 14 days, have you been in close physical contact (6 feet or closer for at least 15 minutes) with a person who is known to have laboratory-confirmed COVID-19 or with anyone who has any symptoms consistent with COVID-19?

NoYes

3. Are you isolating or quarantining because you may have been exposed to a person with COVID-19 or are worried that you may be sick with COVID-19?

NoYes

Are you currently waiting on the results of a COVID-19 test?

NoYes