SMCCCD Campus Access Health Screening Form

Anyone requesting access to a San Mateo County Community College District campus must:

1) Wear a face covering while on the campus.

2) Confirm that you are not experiencing COVID-19 symptoms.

3) Maintain at least 6ft. of social distance from others.

4) Follow the sanitization protocols of using disinfecting wipes and hand sanitizer, as appropriate.


Have you experienced any of the following within the last 14 days?

* Fever or chills
* Cough
* Shortness of breath or difficulty breathing
* Fatigue
* Muscle or body aches
* Headache
* New loss of taste or smell
* Sore throat
* Congestion or runny nose
* Nausea or vomiting
* Diarrhea
* Tested Positive for COVID-19
* Had Close Contact with someone who Tested
Positive for COVID-19

If so, DO NOT COME TO CAMPUS and follow up with your Health Care Professional immediately.

IF you have tested positive for COVID-19, been exposed to someone with COVID-19 symptoms, either confirmed or suspected, and/or have any of the COVID-19 symptoms listed above, THEN notify the District Health Branch Director, Ray Hernandez, immediately at

For more information about returning to campus under the current health guidelines, checkout the SMCCCD Health and Safety information here:

1) Public Safety will confirm upon access to the campus that you have met the Health Screening Requirements above.

2) Arrive early and allow extra time to access the campus and get to your destination.

3) Employees: Don't forget your Employee-issued ID and any office/room keys needed for access. Public Safety will not be available to open facilities.

4) If you would like a copy of the above information, check the box below, provide your email, and press SUBMIT.

5) There is no additional submission needed for this form. The SUBMIT button is only needed if you enter your email to receive a copy of this notification.

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