Chippewa Hotel
Mackinac Island's Best
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906-847-3341
Rooms / Rates
Specials / Packages
Pink Pony
Shop
Merchandise
Gift Cards
Employee Health Test
Employee Health Test
First Name
*
Last Name
*
Date
*
Are you fully vaccinated against Covid-19?
*
Yes
No
Did you vomit in the last 24 hours?
*
Yes
No
Have you had diarrhea in the last 24 hours?
*
Yes
No
Have you experienced shortness of breath in the last 24 hours?
*
Yes
No
Have you had a persistent cough in the last 24 hours?
*
Yes
No
Have you come in contact with a person positive for COVID-19 in the last 24 hours?
*
Yes
No
Unknown
Have you had a fever or felt feverish in last 24 hours?
*
Yes
No
Please record your temperature here if available
Please record any COVID-19 related symptoms you have experienced in the last 24 hours
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