Visitor Form


February 3, 2021

COVID-19 Self-Monitoring Visitor Questionnaire
  • Before visiting Colma's Town facilities, please consider if you have experienced any of the following symptoms in the past 24 hours: Fever or chills (100.4ºF/38ºC or greater) Cough, shortness of breath, difficulty breathing fatigue, muscle or body aches headache sore throat, congestion, runny nose new loss of taste or smell nausea, vomiting, diarrhea, close contact in the last 14 days with an individual diagnosed with COVID-19. If you have experienced any of these symptoms in the last 24 hours you may not visit any of Colma's facilities today. Please reschedule your appointment for at least 14 days from this date. If you have not experienced any of these symptoms in the last 24 hours, you may enter this facility after completing and submitting the following information. If you arrive early, please wait in your car or outside as the lobbies of all facilities are closed. Upon arrival, you will be asked to log in your name, date/time of arrival, and your temperature will be checked.
  • Name * Required
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