DO NOT complete this form if you are in one of the following groups:

  • Penn students, postdocs, faculty, or staff
  • Vendors or contacts

If you are in one of the groups above, please go to:

https://pennopen.med.upenn.edu/

 

Contact
Full Name
Role
Do you meet any of this criteria?
Do not report symptoms of unusual fatigue, fevers, or chills if you received a COVID vaccine within the past 48 hours. If you have other symptoms or these symptoms persist beyond 48 hours, report as usual.
  1. New cough
  2. New difficulty breathing
  3. New loss of taste or smell
  4. Vomiting or diarrhea
  5. Loss of appetite
  6. Unusual fatigue
  7. New rash on fingers or toes
  8. Fever above 100F or feeling feverish (chills, body aches)
  9. In the last week, have you been in contact with someone who has a new fever, new cough, new shortness of breath, or been newly diagnosed with COVID-19?
    1. (Do not include contact if you have tested positive for COVID-19 in the past 90 days, or when you and the other person (e.g., patient or coworker) had on appropriate PPE.).
  10. Have you tested positive for COVID-19 in the past 10 days?