FPC Visitation Form

FIC facility

Photo by FPC

Visit Start Date *
Visit End Date *

Visitors must acknowledge that they are symptom-free from Covid. The key items being implemented to prevent the spread of Covid-19 include:

  • All visitors must wear a facial covering or facemask at all times with the following exceptions.
  • When eating/drinking; however, social distancing practices must be observed.
  • When alone in an office or conference room.
  • The number of visitors is limited based on the Lancaster County Risk Dial found here: Lincoln.ne.gov/city/covid19
  • Moderate/Yellow risk limits our visitors per project to 4.
  • High/Orange risk limits our visitors per project to 2.
  • If Severe/Red level is reached, we cannot receive any visitors (though projects may be operated by our staff and accommodations can be made to share progress remotely).
Visitor Policy *
COVID Health Check

Are you currently, or in the last 14 days experiencing or displaying any of the following symptoms:

  • Elevated temperature or fever of 100.4F or higher,
  • Cough,
  • Shortness of breath and/or difficulty breathing,
  • Loss of smell and/or taste
  • Fatigue, muscle aches, chills, shaking, or
  • Persistent headaches.
Please answer the above statement *
In the last 14 days have you had any close contact with anyone who is either confirmed or suspected of being infected with COVID-19, including anyone who is experiencing or displaying any of the known symptoms of COVID-19 (which are listed below)? *
Purpose of my Visit *