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Ceres Police Department COVID-19 Self-Monitoring Visitor Questionnaire

  1. Before visiting the Ceres Police Department, please consider if you have experienced any of the following symptoms in the past 24 hours:

  2. •Fever or chills (100.4ºF/38ºC or greater)

  3. •Cough, shortness of breath, difficulty breathing

  4. •Fatigue, muscle or body aches

  5. •Headache

  6. •Sore throat, congestion, runny nose

  7. •New loss of taste or smell

  8. •Nausea, vomiting, diarrhea

  9. •Close contact in the last 14 days with an individual diagnosed with COVID-19?

  10. Certification - By entering my name and checking the no symptoms box, I certify that my response is truthful and accurate to the best of my knowledge.

    I understand that the City of Ceres is relying upon the truthfulness of my certification in permitting me to enter the City of Ceres facilities and that there may be adverse consequences for knowingly false responses. I further understand that if I develop any of the above symptoms, I must separate myself immediately from others and notify the City of Ceres immediately.

  11. I certify that I do not have any of the above-listed symptoms.*

  12. Enter your name.

  13. Leave This Blank:

  14. This field is not part of the form submission.