Prospect

Delta College COVID-19 Screening

Are you fully vaccinated for COVID-19 as follows:
At least 2 weeks have passed since you have received the second dose in a 2-dose series, such as the Pfizer or Moderna vaccines, or a single-dose vaccine, such as Johnson & Johnson’s Janssen vaccine.

First Name

Last Name

Phone Number

Email Address

Reason for Visit

Are you a Student, Employee or Visitor?

Do you currently have, or have you had in the past 7 days, any of the following symptoms (NOT due to an underlying medical condition): Fever, Sweats/Chills, Persistent Cough, Shortness of Breath, Sore Throat, Loss of Smell/Taste, Diarrhea, Muscle aches or body aches, Unusual fatigue, Severe headache, Head congestion, Nausea or vomiting?

Have you had any close contact in the last 10 days with someone with a positive diagnosis or presumed positive diagnosis of COVID-19?

Have you been screened by any medical provider for any of the above symptoms in the last 24hrs?

Please check off the locations you plan to visit

- Main Campus
- Planetarium
- Saginaw Center
- Midland Center

I understand that the procedure for entry into any Delta College building, effective March 14, 2022, is as follows

Masks must be worn at all times while indoors.
The Delta College Covid-19 Screening for students, student athletes, faculty, staff members, and visitors available on the Delta College Portal page must be completed before each visit to campus.
The requirement to present a QR code to an entry screener is no longer in place, but screening must still be completed prior to entry.
Greeters will be present at all College entrances to provide masks and provide a reminder to complete health screening prior to entry.

* Required - I understand that failure to comply with these requirements or any falsification or misinformation may result in denial of entry to the facilities of Delta College, suspension of my student status, and/or employee discipline.

I have answered all questions truthfully; and I understand any falsification or misinformation provided may result in criminal action, suspension of my student status and/or employee discipline.