Covid 19 - Attendant Self Screening

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If you answered YES to any of these questions: –DO NOT GO IN TO WORK – Call the agency and the person(s) you care for and tell them you will not be able to provide the services at this time. Make sure to notify agency!

电子邮件地址 *

1.Attendant First Name / Nombre del Asistente

2. Attendant Last name / Apellido del Asistente

3.•Do you have fever (100.3 degrees) or any new respiratory symptoms such as a cough, shortness of breath, irritation or sore throat? •Tiene fiebre (arriva de 100.3 grados) o sintomas respiratorios como tos, falta de aire,garganta irritada?

Yes

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4.•Have you traveled to an area affected by COVID-19 in the last 14 days? •Ha viajado a una area afectada por el COVID-19 en los ultimos 14 dias?

Yes

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5.•Have you had close contact (within 6 feet for more than 15 minutes or lived with) a person with COVID-19 in the past 14 days? •Ha tenido contacto cercano ( a 6 pies por mas de 15 minutos) en los ultimos 14 dias?

Yes

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6.•Have you been diagnosed with COVID-19 or told by a health care provider that you mighthave or have COVID-19?•Ha sido usted diagnosticado con COVID-19 o ha contactado a su proveedor de cuidadosmedicos para comunicarles que sospecha estar contagiado con COVID-19?

Yes

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