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This form shall be used on ALL persons before entering City Hall. This form is to help identify immediate potential risk. Persons who answer “YES” to the following questions should seek further evaluation.
Have you traveled outside of the state of Texas within the last 14-days?
Have you been in close contact with anyone who has been lab-confirmed to have COVID-19?
Shortness of breath or difficulty breathing
Repeated shaking with chills
Fever-Greater than or equal to 100.4 degrees Fahrenheit
Loss of taste or smell
BASED UPON THE RESPONSES, THIS PERSON IS NEGATIVE FOR RISK OF COVID-19
BASED UP0N THE RESPONSES, THIS PERSON NEEDS FURTHER EVALUATION
This field is not part of the form submission.
* indicates a required field