COVID-19 Survey | washpa

top of page

This site was designed with the

website builder. Create your website today.Start Now

Home
Community Gardens
Things to do
WashPA Spaces
Blog
WPO Community
Photo Gallery
Contact Us
File Share
Members
More

Use tab to navigate through the menu items.

Covid-19 Health Declaration

How are you feeling today?

First Name

Last Name

Email

My body temperature is lower than 98.6°F/ 37.5°C

I am not experiencing the symptoms: fever, cough, sore throat

I haven’t been in close contact with a Covid-19 patient in the last 14 days

Initials

Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

WPO Programs are made possible with support from the Washington Citywide Development Corporation, Washington County Historical Society, The City of Washington,

& community volunteers.

Original on Transparent.png

bottom of page