Health Statement before entering the campus Ministry of Health guidelines Full Name * RequiredCell Phone * Required10 digits numbers onlyID number * RequiredE-mail * Required Campus * RequiredNeve Shaanan (Main)Faculty of MedicineSharona campusStatus * RequiredAcademic / Administrative StaffExternal entityOtherAre you coughing? * RequiredNoYesYes, coughing due to chronic condition such as asthma or other allergyIs your body temperature above 38 degrees Celsius or higher now or did you have a fever above 38 degrees over the past week? * RequiredNoYesHave you been in close contact with Corona patient for the past two weeks? * RequiredNoYesWere you tested positive for Covid19 by Naor or any other Covid19 test during last two weeks ? * RequiredNoYes Entrance to the Technion will not be permitted to anyone who did not negate any one of the questionsI declare that the information provided on this form is correct. * Required Approval Signature: * RequiredPhoneThis field is for validation purposes and should be left unchanged.