Your Name (required)
Within the last 10 days have you been diagnosed with COVID-19 or had a test confirming you have the virus? YesNo
Do you live in the same household with (or have you had close contact) with someone who in the past 14 days has been in isolation for COVID-19 or had a test confirming they have the virus? YesNo
Have you or had any one or more of these symptoms today or within the past 24 hours, which is new or not explained by another reason? Fever/chills, cough, shortness of breath, fatigue, body aches, sore throat, loss of taste/smell YesNo
Who are you hear to visit? (Pls. select one) ADLER, MARAANDERSON, TINAARMSTRONG, TABITHABASTIAN, ADAMBAUER, RONALDBENZ, DUSTINBLAKE, KATHYBUNKERS, TODDCARLSON, PETERDEMO, ERICGAUGER, MEGANHANSON, NOELKALLBERG, LINDAKRUEGER, DAVIDKRUEGER, CHRISTOPHERLABORE, LINDSEYLARSON, AMANDALUSTHOFF, WAYNEMAKOUSKY, LIAMCGUIRE, AIMEEOLOFSON-CUSTARD, TESSPASCHALL-HOERST, PATTIPESCH, NATHANPETERSEN, JEFFREYPETERSON, JOELQUARVE, JENAERHODY, DEBORAHRING, STEPHANIEROBERSON, REBECCASCHAEFER, MCKENZIESCHLAWIN, CHADSERRE, STEPHANIESHEEHAN, DANIELSILVER, BENJAMINSMITH, JENNIFERSMITH, LORASTONE, MARCSTUHR, TIMOTHYSUNDERMEYER, AMYVAN HON, SAMUELWHITE, DANIELWURM, NANCY
In the case that an iSpace employee or visitor tests positive for COVID-19, we would like to contact you. Pls. provide your contact information.
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