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EXHIBIT S: COVID-19 SYMPTOMS CHECK

______________________________ ____________
PRINT YOUR NAME TODAY’S DATE

Have you recently begun experiencing any of the following symptoms in a way
that is not normal for you? Please answer “Y” or “N” _______________

Feeling feverish or a measured temperature greater than or equal to

100.0 degrees Fahrenheit

Loss of taste or smell

Cough

Difficulty breathing, shortness of breath

Headache

Chills, shaking or exaggerated shivering

Sore throat

Significant muscle pain or body aches

Diarrhea

Fatigue

Congestion or runny nose

Have you or anyone in your family been lab-tested and been diagnosed with COVID-19
in the last 14 days? Please answer “Y” or “N” _______________

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