COVID-19


COVID-19 SELF-CERTIFICATION QUESTIONNAIRE

Employees shall answer the following questions prior to accessing the workplace.  This process is intended for your own protection as well as the protection of your co-workers.  If you are sick, stay home.  If you answer YES to any of these questions, DO NOT report to work and notify your supervisor immediately.

    Have you, or anyone in your family, come into close contact (within 6 feet) with someone who has a suspected or confirmed COVID-19 diagnosis in the past fourteen (14) days?
    NoYes

    Have you been medically-directed to self-quarantine due to possible exposure to COVID-19?
    NoYes

    Are you having trouble breathing or have you had flu-like symptoms or symptoms of respiratory illness such as cough, shortness of breath, or difficulty breathing in the past 48 hours?
    NoYes

    Are you currently experiencing a fever (greater than 100.4 F or 38.0 C)? Body temperature
    should be measured using a thermometer approved for medical purposes.
    NoYes