Communicable Disease Screening and Attestation Adapted from Rocky Vista University Communicable Diseases Policy of March 4, 2020The online screening and attestation form must be completed on the day of entry, prior to campus access. Any person who is symptomatic with a suspected or confirmed communicable disease of a current epidemic or pandemic (i.e. Influenza or COVID-19) or who may have had a high risk exposure to the disease agent are prohibited from entering RVU buildings for the protection of the RVU community. The included screening questions will be used to help stratify the risks associated with potential exposures. Please answer the following questions:Name* First Last Phone*Email address:* Enter Email Confirm Email Student, employee, or guest?*StudentEmployeeGuestOrganization/Reason for visit:*Campus:*ColoradoUtahWhich class?*MSBSOMS IOMS IIOMS IIIOMS IVPA IPA IIPA IIIHave you experienced a fever (100.4° F or 38° C) accompanied by any one of the possible COVID-19 symptoms (cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea) in the past 14 days?*YesNoIf you are currently sick or experiencing symptoms, please stay home and seek medical attention as necessary. However, if you are now feeling better and not experiencing any symptoms currently, please explain:*In the last 14 days, have you been directly exposed to anyone who has tested positive for COVID-19 (within the last 4 weeks), a suspected person currently under investigation, or a presumed positive person?*YesNoPlease explain:*Is there anything else we should know concerning your current condition that is relevant to the Communicable Disease Policy of Rocky Vista University?By signing my name below, I attest that I have answered all the questions above truthfully to the best of my knowledge. Deliberately providing false information on this attestation will initiate an investigation and may result in disciplinary action. I further attest that I will notify my appropriate manager or curriculum leader immediately should I develop any symptoms of the communicable disease. I understand the purpose of this form and protocol is to assist Rocky Vista University with providing a safe workplace for all employees and students. I further understand that Rocky Vista University is encouraging all employees and students to follow best practices issued by the Centers for Disease Control and Prevention and to stay home if I am ill or have a family member who is ill.*This form is used as a screening protocol only and should not be considered medical care. Rocky Vista University complies with the HIPAA security rule for all covered entities and conducts an annual security risk assessment. All electronic medical information will remain secure following all HIPAA policies and procedures as set forth in the HIPAA policy and procedure manual.