Health Check for Off-Campus Participants Updated on: August 20, 2020 Please complete this form each time before you arrive on campus. Name First Last PhoneEmail Do you have any of the following symptoms? Fever/chills Profound fatigue Headache (typically behind the eyes) Shortness of breath/cough Diarrhea Loss of smell/taste (typically, later in the course of the patient's illness) No Symptoms Have you traveled outside of the country in the last 14 days? Yes No Who are you rehearsing with? AC Wind Symphony AC Jazz Band Fenia Chang Wayne Crannell Daniel Dominick Ricky Duhaime Alan Harkey John McGinn Cathy Richardson Sylvia Rivers