Questionnaire and Requirements

Safe Health Questionnaire 

The Safe Health Questionnaire is available online and in pdf format.


Click here to access the online Safe Health Questionnaire. You will be required to enter your Columbia State PVT username and password to access the form.

Watch the Safe Health Questionnaire video available from the Student Tab of MyCN to learn how to complete the survey. You will only be allowed to submit the questionnaire once daily. Answer the questions honestly and accurately. Upon completion of the questionnaire, you will receive either an Acceptance message indicating you may come to campus on that day or an Access Denied message.

If accepted, make a printout or screenshot of the acceptance message on your phone and bring to campus to show faculty/staff before entering a building. If you cannot bring the acceptance message to campus, staff will be able to check your acceptance status or have you complete a new questionnaire on paper.

Pdf Format:

The purpose of this questionnaire is for you to self-observe your health prior to coming to the college campus. Take your temperature and complete the Safe Health questions every day before coming to campus. If you answer YES to questions 1-5, please stay home and let your instructor know that you cannot attend.

Click here to download a pdf of the Safe Health Questionnaire


Columbia State Requirements

View the Campus Access Requirements.


Responsible Charger Promise

View the Responsible Charger Promise.