COVID Screening Survey


Please complete the following survey for all people in your group (up to 3 total) prior to your arrival at BSC.

* Student's First Name

* Student's Last Name

* Please list the names of up to 2 more people that will be taking the tour with you, keeping in mind that these survey questions apply to all of you.

* Have you or anyone in your party had a positive result for, or other diagnosis with, COVID-19 in the past 14 days?
Yes No
* Do any of you have any of the following symptoms: fever/feverish over 100.4°F, new or existing cough and difficulty breathing?
Yes No
* Have any of you traveled internationally to a country for which the CDC has issued a Level 3 travel health notice within the last 14 days (outside of the United States)?
Yes No
* Have any of you had close contact (as defined by the CDC) with any person who has tested positive for, or has otherwise been diagnosed with, COVID-19 infection within the preceding 14 days?
Yes No
* Have any of you been asked to self-quarantine by a health official within the preceding 14 days?
Yes No

COVID Screening Survey | Bismarck State College