Campus Access Screening Form

1) In the past two weeks, have you or anyone in your household tested positive for COVID-19 or been exposed through close contact to anyone who has tested positive for COVID-19?

Close contact is defined as:
- Being within about six feet of an infected individual for fifteen minutes or longer when one or both of you were not wearing a face covering
- Providing care at home to someone who is sick with COVID-19
- Having direct physical contact (touching, hugging, kissing, etc.) with someone who is sick with COVID-19
- Sharing eating or drinking utensils with someone who is sick with COVID-19
- Being sneezed on by, coughed on by, or somehow coming in contact with the respiratory droplets of someone who is sick with COVID-19

2) Are you experiencing any of the following new or worsening signs or symptoms of COVID-19 that cannot be attributed to another preexisting health condition.

By submitting this form, I agree that the information provided in response to the above questions is accurate to the best of my knowledge, and that I have not withheld any information related to my or anyone in my household's health and/or exposure to COVID-19 within the past two weeks. I understand that Howard Payne University reserves the right to require me to leave the HPU campus immediately if my answers to any of the above questions are "Yes" or are deemed to be inaccurate.

I understand that, if I am permitted to engage in activities on the HPU campus, I must follow the University's stated policies, procedures and protocols related to COVID-19 spread mitigation. The failure to comply by or intentional disregard of the University's COVID-19 spread mitigation policies, procedures and protocols will result in reprimand and potential penalties including, but not limited to, being asked to leave the HPU campus immediately or being permanently trespassed from all University campuses.