Have you traveled or resided outside of Oklahoma within the last 14 days?
Have you attended an event/entertainment venue/gathering or group of greater than 10 people in the last 14 days? The people in your household do not count towards the 10 people.
Have you experienced any symptoms within the last 14 days?
Have you had direct contact with Confirmed (+) COVID-19 within the last 14 days?
Have you had direct contact to someone awaiting COVID-19 test results within the last 14 days?
Do you share a household with anyone who has had symptoms of concern for COVID-19 within the last 14 days?
Do you share a household with anyone who has been instructed to Self-Isolate within the last 14 days?
Do you share a household with anyone who has been diagnosed with COVID-19 within the last 30 days?
Have you tested POSITIVE for COVID-19 within the last 20 days?
The information submitted on this form is complete and accurate to the best of my knowledge.
I acknowledge that this screening tool is being used for clearance to visit Tulsa CARES for the specified reasons and dates stated within this form, based on information I provided. It is not intended for use regarding personal medical evaluation, advice, decisions, and/or treatment. Seek care from your primary care provider or emergency services, as appropriate, for any personal medical needs.
I understand this information is being collected for the purpose of infection prevention and public/employee safety.