• Complete this form and submit it prior to entering our greenhouse facility for your scheduled appointment . If you answer "Yes" to any of the questions below, DO NOT ENTER OUR FACILITY.

  • If you have answered "No" to all five questions, then you may enter our facility. You must continue to follow all public health and workplace control measures including masking, physical distancing, and hand hygiene.

  • MM slash DD slash YYYY
  • :
    Choose "YES" if any are new, worsening, and not related to other known causes including getting a COVID vaccine in the last 48 hours or conditions you already have such as allergies, etc. Select "NO" if you have already completed your isolation period of 5 days, and you don't have a fever, and your symptoms have been improving for over 24 hours (48 hours if you have nausea, vomiting, and/or diarrhea).
  • Check those that apply.
    This includes a positive COVID-19 test result on a lab-based PCR test, rapid molecular test, rapid antigen test, or home-based self-testing kit.
    Select "No" if : * You are 18 or older and have received your booster, and/or * You are 17 or younger and are fully vaccinated, and/or * You completed your isolation after testing positive in the last 90 days (using a rapid antigen, rapid molecular, or PCR test) and/or * Your household member is isolating because of COVID-19 symptoms but has already tested negative on one PCR or rapid molecular test, or two rapid antigen tests