The purpose of this guestbook is to help track COVID-19 outbreaks and inform possibly exposed persons if the need arises. We will not share this information unless so ordered by the New Mexico Dept. of Health.

TMBC Contact Tracing Guestbook

First*

Last*

Email*

Phone*

Type of Visit*

Add a Second Guest Add a Second Guest

First*

Last*

Phone

Type of Visit

PLEASE NOTE: If you answer Yes to any of the three following questions, you may not Check-In and we must, by order of the NMDOH, deny you service. We will not store any of the information recorded below in any way.

Have you been contacted by the NMDOH and/or placed under self-quarantine for COVID-19? Have you been contacted by the NMDOH and/or placed under self-quarantine for COVID-19? Yes No

*Have you (or anyone in your household) in the past 14 days: •Tested positive for COVID-19? •Traveled outside of NM? •Been directly exposed to someone being under investigation for, or with a confirmed case of COVID-19? *Have you (or anyone in your household) in the past 14 days: •Tested positive for COVID-19? •Traveled outside of NM? •Been directly exposed to someone being under investigation for, or with a confirmed case of COVID-19? Yes No

*Have you experienced any of these symptoms today? •Fever over 100.4° •Cough (unrelated to seasonal allergies or asthma) •Shortness of Breath (unrelated to seasonal allergies or asthma) •Loss of Taste or Smell •GI Symptoms (vomit, nausea, diarrhea) •Chills •Headache •Fatigue •Shaking/Chills •Muscle Pain •Sore Throat •Congestion or Runny Nose (unrelated to seasonal allergies) *Have you experienced any of these symptoms today? •Fever over 100.4° •Cough (unrelated to seasonal allergies or asthma) •Shortness of Breath (unrelated to seasonal allergies or asthma) •Loss of Taste or Smell •GI Symptoms (vomit, nausea, diarrhea) •Chills •Headache •Fatigue •Shaking/Chills •Muscle Pain •Sore Throat •Congestion or Runny Nose (unrelated to seasonal allergies) Yes No