Health Screening Form

    Are you fully vaccinated? (If you are not vaccinated, you must wear a mask at My Brother's Keeper)

    COVID 19 SYMPTOM SELF CHECKER

    Have you been diagnosed with COVID-19 within the last 14 days?

    Are you experiencing any of the following symptoms?

    Temperature, GI symptoms, sore throat, cough muscle aches, runny nose, headache?

    If the answer to these symptom self-checker questions is yes, do not volunteer at My Brother's Keeper out of consideration for the health and safety of our community.

    *Please verify that all information is entered correctly before hitting submit.