Circuit Court Check In

To prevent the spread of COVID-19 and reduce the potential risk of exposure to our workforce and visitors, we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measures to protect you and everyone in this building. Thank you for your time.

Health Screening Questionnaire Form

* First Name

* Last Name

* Have you been vaccinated?

Yes

* Have you had any of the following symptoms in the last seven (7) days?

Cough (either new, or different than your usual cough),shortness of breath, or difficulty breathing?
Fever (either subjective, or measured) or chills?
Sore throat, unusual muscle pain, or unusual headache?
New loss of taste or smell?
Nausea, vomiting, diarrhea, or any other flu-like symptoms?

Yes

* In the past week, have you been in close, prolonged contact (less than 6 feet for more than 15 minutes) with someone with fever, cough, shortness of breath, nausea, vomiting, diarrhea, flu-like symptoms, or a diagnosis of COVID-19?

Yes

* Have you had a positive test for COVID-19 infection within the past ten (10) days?

Yes

The Courthouse does not retain any data from this form other than to count the number of vaccinated versus unvaccinated people that enter the building each day.

Email Address Please Note: For In and Out access throughout the day add your e-mail otherwise the form will have to be completed each time you enter.