COVID-19 Visitor Form

Name *

First

Last

Phone *

Email *

Who are you visiting? *

Name of who you are visiting *

First

Last

Email of who you are visiting *

Each email is in the form first intial last name @nfe-engr.com; For example: Bob Davis is bdavis@nfe-engr.com

Please answer "yes" or "no" if you are experiencing any of the following symptoms unrelated to a pre-existing medical condition.

Body Temperature *

Cough *

Excluding chronic cough due to a known medical reason unrelated to COVID-19

Shortness of Breath *

Sore Throat *

Diarrhea *

Excluding diarrhea for known medical reason

Chills *

New Loss of Taste or Smell *

In the last 14 days have you knowingly had close contact with someone with a positive diagnosis of COVID-19? *

In the last 14 days have you travelled via airplane internationally or domestically? *

Name