COVID-19 Wellness Check – Phoenix East Aviation: Forms

Select Campus*

What campus do you operate at? It is very important that you select the correct campus here to avoid any errors.

Details

Name*

Enter your name as it appears on ETA (e.g. Armstrong, Neil).

Phone Number*

Please ensure to enter a correct email address

Email Address*

Please ensure to enter a correct email address

Most Recent Temperature*

Please enter “F” or “C” at the end. E.g. 37.4C or 97.8F

Have you experienced any of these symptoms?

(Select any that apply)

Approximately what date did your symptoms begin?*

In the past 14 days, have you had known or suspected exposure to the SARS-CoV-2 virus or a COVID-19 patient?*

(e.g. been exposed to someone with COVID-19 or been in a large public gathering where exposure is suspected)

Please list the name(s) of whom you think you were exposed to*

Are any of these people affiliated with Phoenix East Aviation?*

Are any of the people you believe to have been exposed to an employee or student at PEA?

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