COVID-19 Class Sign-In

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Effective May 13, 2020, students shall complete this form on a daily basis prior to entering any classroom buildings until further notice.

By signing in, you certify you do not have any of the following symptoms:

• A 100-DEGREE F OR HIGHER FEVER OR FEELING FEVERISH

• A COUGH

• SHORTNESS OF BREATH OR DIFFICULTY BREATHING

• CHILLS

• REPEATED SHAKING WITH CHILLS

• HEADACHES AND/OR BODY ACHES
• MUSCLE PAIN

• NEW LOSS OF TASTE OR SMELL

• SORE THROAT

• NAUSEA, VOMITING, AND/OR DIARRHEA

Email *

First Name *

Last Name *

Location/Classroom Building *

Program of Study *

I certify I am not experiencing any of the symptoms listed at the top of this form. *

I certify

Required

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of CCCC.EDU. Report Abuse

Forms