BLO Individual Health Self-Assessment 2021
To reduce the risk of spreading the COVID-19 virus in and through the community and to protect our employees, patrons, and others, Boston Lyric Opera ("BLO") is implementing procedures for (1) monitoring and/or measuring the temperatures of personnel coming onto BLO work and performance sites; and (2) inquiring and observing whether any individual entering a BLO work or performance site or working on behalf of BLO has any symptoms of COVID-19 or related illness. Any individual whose temperature is measured to indicate a fever, who reports having or is observed to have any such symptoms, or who has recently been in contact with symptomatic individuals will not be permitted to enter any BLO work or performance site or perform any work on behalf of BLO and is instructed to seek appropriate medical advice.

If you have experienced any symptoms or have any questions, please stay at home and email boxoffice@blo.org

All information shared on this form will be kept confidential.
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Instructions: This Health Self-Assessment must be completed every day until further notice prior to the beginning of any entry onto a BLO work or performance site or the beginning of any work shift. Upon arrival, you are required to have your temperature taken and to confirm that you are free of COVID-19 symptoms, as defined by the CDC. Complete this Health Self-Assessment. The completed form will be maintained confidentially If you refuse to cooperate in the Health Self-Assessment process, you will not be permitted to enter a BLO work or performance site and will be asked to leave the site. *
Required
I am filling out this screening form because: *
What date are you entering the BLO work space or event? *
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What BLO event or work space are you entering? *
Name *
Phone Number *
E-Mail Address *
We are asking everyone to perform a self-assessment at home, check their temperature, and make note of any COVID symptoms (symptoms include cough, shortness of breath or breathing difficulty, fever/feeling feverish, chills, muscle pain/body aches, headache, sore throat, new loss of taste or smell). Have you done a self-assessment and remained symptom-free for the last 14 days?
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Have you been in “close contact” with an individual diagnosed with COVID-19? “Close contact” means living in the same household as a person who has tested positive for COVID-19, caring for a person who has tested positive for COVID-19, being within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period starting from 2 days before illness onset (or, for asymptomatic patients, 2 days prior to test specimen collection) until the time the patient is isolated, or coming in direct contact with secretions (e.g., sharing utensils, being coughed on) from a person who has tested positive for COVID-19, while that person was symptomatic.
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Have you been asked to self-isolate or quarantine by your doctor or local public health official?
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If you have any symptoms of COVID-19 (as defined by the CDC) you and/or BLO designated personnel must immediately notify the COVID-19 Supervisor. You will be asked to leave the BLO work or performance site and advised to follow CDC and Occupational Safety & Health Administration (OSHA) guidelines for self-quarantine and, if an employee, returning to work. You must notify the COVID-19 Supervisor as to when the symptoms started and with which other individuals you have had contact. By filling out this form you signify that you understand this and that all information submitted in this form is true and correct. *
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