In our efforts to minimize the transmission and spread of COVID -19, please complete the following questionnaire on behalf of yourself and all individuals within the home, prior to submitting your maintenance request.

1.) Have you or anyone within the home tested positive for COVID – 19 within the last 14 days?
2.) Within the last 14 days did you provide care or have contact with a symptomatic person known or suspected to have COVID-19?
3.) Please select YES if you or anyone within the home are currently experiencing any of the following symptoms:
  • Fever
  • Chills
  • Cough or worsening of chronic cough
  • Shortness of breath
  • Sore throat
  • Runny nose
  • Loss of sense of smell or taste
  • Headache
  • Fatigue
  • Diarrhea
  • Loss of appetite
  • Nausea and vomiting
  • Muscle aches
  • Stuffy nose
  • Conjunctivitis (pink eye)
  • Dizziness, confusion
  • Abdominal pain
  • Skin rashes or discoloration of fingers or toes