APPROVED VENDORS & VISITORS FORM
Please complete form below. (*) asterisk indicates required field.
*First Name Vendor/Visitor:
*Last Name Vendor/Visitor
*E-mail:
*Phone:
Organization or Affiliation:
*Please check which best describes you:
Vendor
Visitor
Employee
Student
Do you reside in campus housing?
Yes
No
MU Primary Contact Name:
MU Primary Contact Email:
*Reason for Visit:
*Do you have any of the following new symptoms?
Fever (100.0)
Chills & repeated shaking with chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle pain or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
Yes
No
*Are you living with or caring for an individual who is a suspected or confirmed case of COVID-19?
Yes
No
*In the last 14 days have you been exposed (You were within 6 feet of someone who has COVID-19 for a total of 15 minutes of more) to someone who tested positive for COVID-19?
Yes
No
*Are you currently in isolation as the result of a confirmed positive COVID-19 test result?
Yes
No
*Are you currently awaiting results from a COVID-19 test?
Yes
No
to certify all the information provided is correct to the best of my ability.
