Our Residents

Name

Email Address

Phone

Apartment Number

Describe the Problem

Have you or any other household member had a fever of 100.4 °F or greater in the past 14 days? Have you or any other household member had a fever of 100.4 °F or greater in the past 14 days? Yes No

Have you or any other household member exhibited any of these symptoms in the past 14 days including cough, shortness of breath, diarrhea, fatigue, headache, muscle aches, nausea, loss of taste or smell, sore throat, vomiting, etc Have you or any other household member exhibited any of these symptoms in the past 14 days including cough, shortness of breath, diarrhea, fatigue, headache, muscle aches, nausea, loss of taste or smell, sore throat, vomiting, etc Yes No

Have you or any other household travelled nationally or internationally the past 14 days? Have you or any other household travelled nationally or internationally the past 14 days? Yes No

Have you or any other household been in close contact with a person who has been diagnosed with, tested for, or quarantined as a result of COVID-19 the past 14 days? Have you or any other household been in close contact with a person who has been diagnosed with, tested for, or quarantined as a result of COVID-19 the past 14 days? Yes No