Fall 2020 UMaine COVID-19 Self-Screening Questionnaire

The health and safety of our employees, students, vendors and visitors remain our top priority. As the COVID-19 pandemic continues to evolve and spread globally, we continue to monitor the situation closely and may periodically update company guidance based on current recommendations from the government and federal Center for Disease Control and Prevention (CDC).

To prevent the spread of COVID-19 and reduce the potential risk of exposure to our employees and visitors, we are instituting a screening questionnaire and medical symptom check. Your participation is important to help us take precautionary measure(s) for the health and safety of everyone. 
Personal Information

COVID-19 Questionnaire

Have you experienced any of these symptoms in the last 14 days?

If you answered “yes” to any of the symptoms listed above, please reschedule your campus visit for a different time. 
Additional Exposure

If you answered “yes” to any of the questions listed above, please reschedule your campus visit for a different time. 
Be completing and submitting this COVID-19 Screening Questionnaire you acknowledge and agree that:
  •  I have truthfully answered all the questions on this questionnaire to the best of my knowledge. I further agree to check my temperature and symptoms daily to determine if my answers to this questionnaire need to be amended. If they do, you agree to reach out to us at: um.campustours@maine.edu
  • I agree to a temperature check as I arrive on campus.
  • I acknowledge that if my temperature exceeds 100.4 °F, or if I exhibit symptoms of COVID-19 as described above, or a diagnostic test returns positive for COVID-19 I will not come to visit campus.