Health Screening & Travel Information

Health & Wellness is a priority at NC State

Welcome to North Central State College. Our priority is to maintain a safe environment for the students, faculty and staff of North Central State College. You’ve been directed to this form because of your answers to health screening questions, your recent travel activity, or your temperature as you arrived was above 100.4 degrees. Please fill out and submit the following information. We will be in touch as soon as we review your submission.

Thank you for understanding and for providing us with information that helps maintain the safety of everyone on our campus.

  • Name * Required
  • If you are a student, what division are you enrolled in this semester?
  • 1. Have you cared for anyone with COVID-19 in the past two weeks without wearing appropriate Personal Protective Equipment (PPE)?
  • If you answered yes, are you monitoring yourself for symptoms?
  • Have you been contacted by a healthcare agency and advised to quarantine?
  • Date Format: MM slash DD slash YYYY
  • 2. Have you, or a member of your household, traveled to a level 3 country?
  • If you traveled to a country with a Level 3 travel advisory, you will be asked to remain home for 14 days. Click here for a current map that includes the CDC Travel Advisories. (Opens in a new tab)

  • 3. Have you, or a member of your household, traveled to a domestic hotspot for COVID-19?
  • If you traveled to any state reporting positive testing rates of 15% or higher for COVID-19, you will be asked to remain home for 14 days. Click here for a current map that includes states considered hotspots. (Opens in a new tab)

  • 4. Have you traveled on a cruise ship?
  • Date Format: MM slash DD slash YYYY
  • If you traveled to a country with a Level 3 travel advisory, to a domestic hotspot, or on a cruise ship, you will be asked to remain home for 14 days. Are you able to work from home during quarantine?
  • 5. Have you developed a new cough or sneeze?
  • Are your symptoms:
  • 6. Have you developed a new loss of smell or taste?
  • Are your symptoms:
  • 7. Have you developed any flu-like symptoms?
  • You should not be here regardless of cause if you have flu like symptoms
  • 8. Do you have a fever above 100.4?
  • You should not return until you have three days of being fever free with no medications