COVID-19 Screening Form


ADOS – Active Duty Operational Support | TDG – Traditional Drilling Guardsman | DSG – Drill Status Guardsman | SAD – State Active Duty | AT – Annual Training | RUTA (ANG) – Rescheduled Unit Training Assembly | SUTA (ARNG) – Substitute Unit Training Assembly
Please select your Rank/Status for the day reporting. (ie; If you are in a technician status for the date reporting use Technician, if you are in a drill status, use your Rank, etc…)
**NOTE: Exposure is as defined by the CDC as “close contact,” ie: cumulative of 15minutes or more within 6ft of a confirmed COVID positive over a 24 hour period regardless of PPE. If you select YES to this question, you SHOULD NOT report to work. Please contact your supervisor and await contact from MEDCOM for ARNG personnel or MDG for ANG Personnel.
If you select YES to this question, you SHOULD NOT report to work. Please contact your supervisor and await contact from MEDCOM for ARNG personnel or MDG for ANG Personnel.
If you select YES to this question, you SHOULD NOT report to work. Please contact your supervisor and await contact from MEDCOM for ARNG personnel or MDG for ANG Personnel.
If you select YES (unvaccinated) to this question, you SHOULD NOT report to work. Please contact your supervisor and await contact from MEDCOM for ARNG personnel or MDG for ANG Personnel.

By signing below, you certify that the information provided is true and correct to the best of your knowledge and belief: