Mayor's Office of Special Events

Health Event Pass Survey

The COVID-19 information on this form is derived from CDC guidelines in consultation with the City of Houston Health Department.  This survey is not for the general public.

To help control the spread of COVID-19, share any possible symptoms and report any contact with others. Please answer all questions truthfully. Your answers are private and will not be shared with anyone.






6. Email Address

7. PRIOR HISTORY – Have you been turned away from another facility in the last 7 days?

8. SYMPTOMS – Have you exhibited any of the following COVID-19 SYMPTOMS in the last 7 days?

9. IF YOU ANSWERED YES TO ANY OF THE ABOVE SYMPTOMS, PLEASE COMMENT ON YOUR SYMPTOMS

10. TESTING – Do you or a person you live with, have a pending or positive COVID-19 test?

11. CLOSE CONTACT – Have you had close contact with a person having a suspected or laboratory-confirmed COVID-19 case within the last 14 days? Close contact is defined as being within approximately 6 feet (2 meters) of a COVID-19 case, e.g. being coughed on. Close contact can occurr while caring for, living with, or sharing a healthcare waiting area or room with a COVID-19 case.

12. INTERNATIONAL TRAVEL – Have you returned from international travel to a region with a Level 3 Health Notice or traveled via a cruise ship within the last 14 days?

13. DOMESTIC TRAVEL – Have you returned from domestic US travel to a location with a Domestic Travel Advisory within the last 14 days?

14. CONSENT – I hereby state that I have answered the above questions honestly and to the best of my abilities. All personal information will be kept confidential and will only be used to help control the spread of COVID-19. This form is voluntary but it is required before anyone can access an approved City of Houston event: (please check this box)


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