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In-person event participants, including minors, must complete this COVID-19 health screening within 24 hours of the event. Guardians may complete the assessment for minors.

Have you experienced any of the following symptoms in the past 48 hours (unless due to your seasonal allergies):

  • fever or chills
  • cough
  • shortness of breath or difficulty breathing
  • fatigue
  • muscle or body aches
  • headache
  • new loss of taste or smell
  • sore throat
  • congestion or runny nose
  • nausea or vomiting
  • diarrhea

Within the past 14 days, have you been unprotected in close physical contact (6 feet or closer for a cumulative total of 15 minutes) with:

  • Anyone who is known to have laboratory-confirmed COVID-19?


  • Anyone who has any symptoms consistent with COVID-19?

Are you isolating or quarantining because you may have been exposed to a person with COVID-19 or are worried that you may be sick with COVID-19?

Are you currently waiting on the results of a COVID-19 test?


Please print or take a screenshot of this approval with the date and time. You will show this to staff at the event.

Not Approved
In order to protect the health and safety of fellow participants, please do not come to the event. Call your primary care provider for further instructions.

Valid for:

Asthma Basics Workshop - National
, | Apr 17, 2024
Asthma Basics Workshop - National
, | May 07, 2024