Madonna University Daily COVID-19 Self-Screening Questionnaire for Visitors

Until Madonna University’s plan for fully reopening campus to students and visitors is implemented, all Madonna University students and visitors to campus are asked to come to campus by appointment only.  For your own health and safety and that of our faculty, staff, and the community, you are required to complete this questionnaire daily and to take your temperature at home BEFORE reporting to campus for your appointment. This will aid the University in conducting contact tracing, should that become necessary.  A “fever” is considered a temperature of 100.4°F or above.  Please provide your name, e-mail address and the individual or University department with whom you have an appointment (e.g. Admissions, Financial Aid, etc.).

Name:

Email Address:

Person or department with whom you have appointment?

Please select “YES” if any of the following apply to you and “NO” if none of the following apply to you. 

1. Do you have symptoms of fever, chills, headache, cough, shortness of breath, sore throat, loss of smell or taste, runny nose or congestion, muscle aches, fatigue, abdomen pain, nausea, vomiting or diarrhea? 
2. Have you had close contact in the last 14 days with an individual diagnosed with COVID-19? 
3. Have you traveled on an airplane internationally in the last 14 days?

If a student or visitor answers “Yes” they should stay home, self-isolate/self-quarantine at home until the following is completed:

• • Call a medical provider to be evaluated. If you are diagnosed as a probable COVID-19 or you test positive, you should call your local health department and make them aware of your diagnosis or testing status.

• • If any of the above symptom(s) are present, but a minimum of 10 days have elapsed since the symptom(s) first appeared and 3 days have elapsed without fever, and there has been an improvement in any respiratory symptom(s), you may come to campus (or as directed by a medical professional).

• • 14 days if the individual had close contact with an individual diagnosed with COVID-19 but the individual has not developed symptoms.

• • 14 days following international travel via airplane.
  
  

You should also notify the University department or individual with whom you are meeting to reschedule your appointment.