MC - CITY OF LOVINGTON, NEW MEXICO

Municipal Court

* Indicates required field

Name *

First

Last

Email *

1. Have you had a fever greater than 100.4 F OR have you exhibited any symptoms related to coronavirus (COVID-19), i.e. cough, sore throat, shortness of breath, chills, muscle pain, headache, new loss of taste or smell, fatigue, congestion or runny nose, nausea or vomiting, or diarrhea in the last 14 days? *

YES NO

2. Have you travelled out of the State of New Mexico during the past 14 days for non-job related purposes? *

YES NO

3. During the past 14 days, have you come into close contact (less than 6.5 feet) for a period of greater than 3 minutes with someone who has a confirmed COVID-19 diagnosis and you were not wearing a face mask or cloth face covering? *

YES NO

Submit

​Municipal Court

Municipal Court