Washtenaw County Pandemic Screening Questions

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YOU MUST COMPLETE THIS DAILY BEFORE REPORTING TO WORK.

Your Name *

Date *

YYYY

Your temperature this morning was... *

Do you have symptoms of a cough, shortness of breath, sore throat or diarrhea? *

Have you had close contact in the last 14 days with an individual diagnosed with COVID19?

Have you traveled via airplane internationally or domestically within the last 14 days (I know, we are required to ask)? *

No, I have not.

Yes, DO NOT REPORT AND CALL MARK OR KRISTIN IMMEDIATELY

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