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VOANCE HAIR SALON - Daily COVID-19 Screening for Employees
This form needs to completed and submitted by all employees of Voance Hair Salon every day before coming to work. If your answers indicate "The employee may not report to work", please stay home and let us know.
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* Indicates required question
Full Name
*
Your answer
Do you currently have a fever of 100.4 degrees F or greater?
*
Yes - No further screening is needed. The employee may not report to work.
No - Go to the next question.
Do you have a cough or shortness of breath that began within the past 14 days?
*
Yes - No further screening is needed. The employee may not report to work.
No - Go to the next question.
In the past 14 days, have you gotten a positive result from a COVID-19 test that tested saliva or used a nose or throat swab? (not a blood test)
*
Yes - No further screening is needed. The employee may not report to work.
No - Go to the next question.
In the past 14 days, have you been in close contact (within 6 feet for at least 10minutes) with anyone who either tested positive for COVID-19 (not a blood test) or developed symptoms of COVID-19 (fever, cough, or shortness of breath)?
*
Yes - No further screening is needed. The employee may not report to work.
No The employee may report to work.
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