Pearlstone Entry Form 2022-23

Pearlstone prioritizes the health and safety of our visitors, guests, and staff above all else. This form must be completed on the day that you plan to come to Pearlstone’s campus. Once you receive a green pass, you must show the screen capture or email to the security guard to proceed onto campus. If you receive a red alert please contact Eve Wachhaus at 410-500-5374 or ewachhaus@pearlstonecenter.org for instructions and do not proceed to Pearlstone until cleared by appropriate parties.

QUESTIONNAIRE to be completed each day before entry onto Pearlstone property:
Name Name First Last
Date you will be at Pearlstone Date you will be at Pearlstone / MM / DD YYYY
Email
Since your last day of visiting our property:
Have you been confirmed by a health care provider to have COVID-19 in the past 10 days?

Have you been confirmed by a health care provider to have COVID-19 in the past 10 days? YES NO
Are you currently awaiting COVID-19 testing results?

Are you currently awaiting COVID-19 testing results? YES NO
Have you been in close contact (within 6 feet) with an individual who is under investigation for COVID-19 or who has been diagnosed to have COVID-19 as determined by a health care provider in the past 5 days?

Have you been in close contact (within 6 feet) with an individual who is under investigation for COVID-19 or who has been diagnosed to have COVID-19 as determined by a health care provider in the past 5 days? YES NO
Are you exhibiting any of the symptoms associated with COVID-19 that cannot be attributed to another health condition and/or physical activity?

Are you exhibiting any of the symptoms associated with COVID-19 that cannot be attributed to another health condition and/or physical activity? YES NO
***I will notify Pearlstone if I or anyone in my household tests positive for COVID-19 within 14 days of my visit to the campus.

Pearlstone Entry Form 2022-23

Pearlstone Entry Form 2022-23

QUESTIONNAIRE to be completed each day before entry onto Pearlstone property:

Since your last day of visiting our property:

***I will notify Pearlstone if I or anyone in my household tests positive for COVID-19 within 14 days of my visit to the campus.