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Driven Leadership COVID Health Screening: BOLD Advanced Leadership

Driven Leadership COVID Health Screening: BOLD Advanced Leadership

Ensure your safety at BOLD: Advanced Leadership events. Complete this quick COVID Health Screening Questionnaire and rapid test to align with CDC guidelines, minimizing risks in our sanitized, socially distanced environment.

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COVID Health Screening Questionnaire

The health and safety of our BOLD: Advanced Leadership students is our number one priority. We are doing everything in our power to adhere to the CDC guidelines during your time with us. The COVID Health Screening Questionnaire and taking the Rapid COVID test prior to BOLD help alleviate some of the fears and uncertainty of being at a live event.

We will provide you with gloves, masks, and hand sanitizer. We have designated staff to wipe down the room before and after class and during breaks. We will be taking your temperature daily. We ask that if when you aren’t able to socially distance, that you wear a mask.

Please answer the following questions:

Name*
Date*
Position

Are you currently experiencing, or have you experienced in the last 14 days, any of the following symptoms that cannot be attributed to another health condition?*

In the past 14 days, have you been in close proximity to anyone who was experiencing any of the above symptoms or has experienced any of the above symptoms since your contact?*

Have you had contact with a person known to be infected, potentially infected, or exposed to someone infected with the COVID-19 within the previous 14 days?*

Have you been advised to self-quarantine in the last 14 days because of exposure to someone with COVID-19?*

Have you been tested for COVID-19 in the last 48 hours?*

In the event I contract COVID-19 within the next two weeks, I will notify Driven Leadership as soon as possible.*

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