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COVID-19 Daily Sign-In - BLDG G

  1. Do you have a new cough or worsening cough (excluding chronic cough due to known medical condition)?*
  2. Do you have shortness of breath or breathing difficulties?*
  3. Have you had any close contact in the last 14 days with someone who has or may have a COVID-19 diagnosis?*
  4. Have you traveled internationally, or to an area outside of Michigan with a high number of COVID-19 cases in the last 14 days?*
  5. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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  7. This field is not part of the form submission.