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Student Health Assessment

Location
I plan to be on campus in the

Mandatory Training

Instructions

To meet health compliance regulations, it is required that you participate in this daily risk assessment each day you come to either campus. It is important that all questions are answered truthfully for your safety and the safety of your instructor and classmates.

If you have any of the following emergency warning signs for COVID-19, you should NOT come to campus. Please inform your instructor of your illness and immediately seek medical attention.
  • Difficulty Breathing
  • Pressure or Pain in Chest
  • Confused or Hard to Wake
  • Bluish lips or face
Have you experienced any of the following symptoms in the last 24 hours?
Fever (a fever is a temperature at or above 100.4°F)
Cough
Shortness of breath or difficulty breathing
Fatigue
Chills
Congestion or Runny Nose
Sore throat
New loss of taste or smell
Gastrointestinal problems such as nausea, diarrhea or vomiting
Muscle or Body Aches
Headache (unless caused by an identifiable source such as new eyeglasses)
In the last 14 days have you been in close, prolonged contact with anyone with a confirmed or presumed case of COVID-19 (“close, prolonged contact” is defined as 15+ minutes within a physical distance of six-feet, or unprotected direct contact to body fluids)?
Have you been instructed to quarantine or self-isolate by a licensed health care provider or the Department of Health?
Have you traveled internationally or via commercial airplane in the past 14 days?
Have you engaged in non-essential travel to other states or countries within the last ten calendar days (except as necessary to meet urgent critical healthcare staffing needs or to otherwise engage in emergency response. This does not apply to individuals who routinely cross state or country borders solely for the purpose of essential travel)?

Yes - you may come to campus.

Acknowledgement

By submitting this form, you affirm you have followed all the instructions and provided complete and accurate information.

Not Approved

DO NOT come to campus.

If you answered “Yes” to any other question, please notify your Instructor about your absence. You should consult with a licensed health care provider immediately and contact the Student COVID-19 Compliance Officer at the Student Health and Wellness Center at (661) 362-3259. To find a free COVID-19 L.A. County Testing Site, please visit: https://lacovidprod.service-now.com/rrs