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Visitor Check-in
First Name:
Last Name:
Contact Phone Number:
Contact Email:
What is the date of your campus visit?
What are the approximate start and end times of your visit?
Start Time:
12:00 AM
1:00 AM
2:00 AM
3:00 AM
4:00 AM
5:00 AM
6:00 AM
7:00 AM
8:00 AM
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
5:00 PM
6:00 PM
7:00 PM
8:00 PM
9:00 PM
10:00 PM
11:00 PM
End Time:
12:00 AM
1:00 AM
2:00 AM
3:00 AM
4:00 AM
5:00 AM
6:00 AM
7:00 AM
8:00 AM
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
5:00 PM
6:00 PM
7:00 PM
8:00 PM
9:00 PM
10:00 PM
11:00 PM
Which buildings and rooms do you plan on visiting while on campus?
Purpose of visit:
I attest that I have
not
experienced any of the following symptoms in the past 48 hours:
A new fever (100.4°F or higher), or a sense of having a fever;
A new cough that cannot be attribute to another health condition;
A new shortness of breath that cannot be attribute to another health condition;
A new sore throat that cannot be attribute to another health condition;
A new headache that cannot be attribute to another health condition;
A new loss of taste or smell that cannot be attribute to another health condition;
New chills or repeated shaking with chills that cannot be attribute to another health condition;
New muscle that cannot be attribute to another health condition or that may have been caused by a specific activity, such as physical exercise.
Yes
No
I also attest that I have
not
tested positive for COVID-19 within the past 14 days, nor have I been exposed to someone in my household or otherwise who has a positive COVID-19 test result within the past 14 days.
Yes
No
I understand that if I present symptoms or feel ill while present on Bellevue College Campus, I must leave the premises and notify Bellevue College Public Safety immediately by calling (425) 466-9365.
Yes
No
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We are an equal opportunity institution