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Campus Visitor Log Form for COVID-19

* = required field

Some content may be updated based on selection

Role on Campus

First Name

Last Name

Phone number (for visitors only)

Additional vehicle occupants:

First Name

Last Name

First Name

Last Name

First Name

Last Name

Checklist:

Do they have a mask with them?
If not, give them a disposable mask. Ask them to put the mask on for screening. [we don't need to log a response]

Take their temperature:

Do they currently have a fever (temperature 100.4 over above)?

Have you knowingly been in close or proximate contact in the past 14 days with anyone who has tested positive for COVID-19 or who has or had symptoms of COVID-19

Have you tested positive for COVID-19 in the past 14 days; or

Have you experienced any symptoms of COVID-19 in the past 14 days (fever, cough, shortness of breath, or at least two of the following symptoms: fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell)?ed any cold or flu-like symptoms in the last 14 days (to include fever, cough, sore throat, respiratory illness, difficulty breathing)?

What building(s) they plan to visit:

Academic II

Coyne Hall

Coulter Library

Ferrante Hall

Gordon Student Center

Mawhinney

Mulroy Hall

SRC Arena

Service and Maintenance

Whitney Applied Technology Center

Other (drop off/pick off, walking outside, etc)

Residence Halls

OCC @ Liverpool

Photo of drivers licence (only visitors with no phone number):

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Give them a sticker if they pass all the screening questions.

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