Employee Daily Health Screening Questionnaire
This questionnaire is  provided in accordance with access protocols identified by the Santa Barbara County Public Health Department. ALL employees, students, and visitors entering any college-operated buildings must answer the following Screening Questions EVERY DAY before entering the facilities.

(IMPORTANT: An employee who fails to complete the screening process must be denied access to the SBCC campus. If your answer to any of the questions in this questionnaire indicates that you are not cleared, do not come to school, and call your physician to consider self-quarantine.)

**Take your temperature each time to be sure you do not have a fever**

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Email *
Employee's Name: *
Employee's "K" Number: *
Have you experienced any of the following symptoms in the past 48 hours: fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea? *
Within the past 14 days, have you been in close physical contact (6 feet or closer for at least 15minutes or more within a 24 hour period) with a person who is known to have laboratory-confirmed COVID-19 or with anyone who has any symptoms consistent with COVID-19? *
 Are you isolating or quarantining because you may have been exposed to a person with COVID-19 or are worried that you may be sick with COVID-19? *
 Are you currently waiting on the results of a COVID-19 test? *
A copy of your responses will be emailed to the address you provided.
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