Visitor Prescreening Form | Cleveland Metroparks

*First Name:

*Last Name:

*Email Address:

*Phone Number:

( ) -

*Department you are visiting:

*Location you are visiting:

*Are you currently under an isolation order or within a required quarantine period? :

YesNo

*Do you currently have symptoms of COVID-19 (fever, cough, trouble breathing, chills, repeated shaking with chills, muscle pain, headache, sore throat, new loss of taste or smell)? :

YesNo

*In the past seven (7) days, have you had symptoms of COVID-19 (fever, cough, trouble breathing, chills, repeated shaking with chills, muscle pain, headache, sore throat, new loss of taste or smell)? :

YesNo

*In the past seven (7) days, have you been within six (6) feet, lived with or cared for someone that tested positive for COVID-19? :

YesNo

*Do you reasonably believe you have been within six (6) feet, lived with or cared for someone suspected of having COVID-19? :

YesNo

*In the past seven (7) days, have you traveled outside of the state of Ohio? :

YesNo