Visitor Check In

Visitor Campus Access Form

This attestation was developed with guidance from the Spokane Regional Health District.

all fields required

Check In:

First Name:

Last Name:

Phone:

Email Address:

Campus:

Name of campus contact:

Health Status Screening

Before you go to campus/work, please document your health status.

IF YOU HAVE ANY SYMPTOMS OF COVID-19, PLEASE CONTACT A MEDICAL PROFESSIONAL.

VISITORS SHOULD NOTIFY THEIR CAMPUS CONTACT THAT THEY ARE NOT COMING DUE TO COVID-19 SYMPTOMS. PLEASE ALSO NOTIFY YOUR CAMPUS CONTACT IF YOU HAVE BEEN DIAGNOSED WITH COVID-19.

Health Survey

Before leaving your home to go to Community Colleges of Spokane (CCS), Spokane Community College (SCC), or Spokane Falls Community College (SFCC), review the symptom list below and answer the following questions.

Fever
Chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion
Nausea or vomiting
Diarrhea

Have you experienced any of the symptoms listed above in the past 14 days that you cannot attribute to another condition?

Yes
No

Within the past 14 days, have you had close contact with anyone that you know has been diagnosed with COVID-19? Close contact is defined as 15 cumulative minutes of exposure at a distance of 6 feet or less with a person.

Yes
No

Have you had close contact with someone who has any of the symptoms listed above AND is awaiting a COVID-19 test result OR have you been told by a public health or medical professional to self-monitor, self-isolate, or self-quarantine because of concerns about COVID-19 infection?

Yes
No

Have you had a positive-COVID test for active virus in the past 10 days?

Yes
No

If you plan on visiting somewhere besides your work area/visit area when you are on campus and will be in close contact with other people, which means closer than six feet away for more than 15 minutes, please enter those locations below.

If you answered "YES" to any of the questions above,
- Please notify your campus contact you will not be coming to campus and why.
- You are encouraged to be tested for COVID-19.
- If you do not have a doctor or healthcare provider, free or low-cost testing is available at several locations in Spokane to anyone. If you live in a different county please click here for testing locations.
- You may return to campus once you have completed a quarantine or isolation period or if you provide a statement from a medical professional stating that you do not have a contagious illness and the symptoms you exhibited are not because of COVID-19.
If you answered “NO” to all questions then you may come to campus as planned.

Once you submit this form you will receive an email confirming your response. Thank you for your cooperation.

Your submission of this document is your electronic signature that at the time and date of submission the above documentation is correct to the best of your knowledge.

Acknowledge statement:

Yes

When documenting your departure, you should list all areas that you accessed during your stay. Please note the departments and offices you visited today.

List the names of those you met where contact was both within six feet and lasted 15 minutes or longer.