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ASU Mid-South | West Memphis, Arkansas

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Daily Health Screening Questionnaire

The Centers for Disease Control (CDC) lists symptoms of COVID-19.

Have you had any of the following NEW symptoms in the last 5 days:

  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea

OR – In the past 5 days, do you know if you have been in close contact (less than 6 feet apart for cumulative total of more than 15 minutes in a 24-hour period) with someone with fever or chills, cough, sore throat, shortness of breath, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea, OR a diagnosis of COVID-19

  • DO NOT COME TO CAMPUS! To protect your health, and the health of others at ASU Mid-South, you are required to complete the ASU Mid-South COVID-19 Reporting Form and follow the next steps provided by ASU Mid-South staff regarding your return to campus. You should seek medical guidance. If you are a student, YOU MUST ALSO notify your instructor. If you are an employee, YOU MUST ALSO notify your supervisor. Click the button below to go to the ASU Mid-South COVID-19 Reporting Form

     
    ASU Mid-South COVID-19 Reporting Form
  • You do not have to complete the ASU Mid-South Reporting Form IF you ARE FULLY VACCINATED

    meaning it has been two or more weeks since you received the second dose in a 2-dose series, or two or more weeks since you received one dose of a single-dose vaccine, AND you have remained asymptomatic since the recent COVID-19 close contact. You DO NOT need to quarantine unless you develop symptoms of COVID-19.
  • Thank you for taking the Daily Health Assessment. Remember, masks are required on the ASU Mid-South campus.

    Also remember, wash your hands frequently and maintain appropriate distances from others. Stay safe and be well.
  • This field is for validation purposes and should be left unchanged.

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ASU Mid-South

2000 West Broadway

West Memphis, AR 72301

Main – 870.733.6722
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