COVID 19 Questionnaire

General Form (No Login)

There is nothing more important to us than the safety of our students and staff. For this reason, we want to ensure that we address every possible risk. Please answer the following questions below as a pre-screening for entrance onto campus at Piedmont Technical College.


Personal Information

Must be in format P########.
Please input the email of the person you are meeting with on campus.

Questions

Per the CDC's guidelines, we will postpone any in-person contact until you have stayed home for 14 days to practice social distancing. Please contact your primary care physician.

  • Students: please contact us to set up a remote appointment.
  • Employees: please contact your supervisor.

Please contact your instructor or supervisor for approval prior to coming to campus.

What is your temperature? Must be in format ex: 98.6.

Are any of the following true for you?

  • Are you isolating or quarantining because you may have been exposed to a person with COVID-19?
  • Are you currently waiting on the results of a COVID-19 test?

Within the past 14 days, have you been 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?
  • OR
  • Anyone who has any symptoms consistent with COVID-19?

Were you at a clinical site and wearing site-approved PPE during this contact?

Do you currently have any of the symptoms representative of COVID-19? These symptoms include:

  • 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

Certification

Confirmation

Submission