Stay Safe Precaution Agreement

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This health screening form MUST be completed for all volunteers no earlier than 12 hours before serving.

Anyone with unknown illness with COVID symptoms: respiratory infection, fever above 100.4, and/or a productive cough within the last 10 days are NOT allowed to serve for the safety of others. If you have been in close contact (more than 15 minutes) with anyone an unknown sickness with symptoms related to COVID-19, please do not volunteer until 10 days after their symptoms disappeared or a negative COVID-19 test result is received.

In the interest of all volunteers and those we serve, we reserve the right to send you home if you do present any symptons upon arrival or answer yes to questions 1, 2, and 4 and no to 3 below.

Email *

Name: *

1. In the last 10 days, have you had any undiagnosed vomiting, diarrhea, fever, cough, sore throat or shortness of breath? If flu, and over OK to serve. *

YES

2. In the last week, have you been sick or around anyone who has been sick? *

YES

3. Have you traveled by air or been in close contact with anyone who has returned from air travel within the last 10 days? *

YES

4. Do you agree to washing your hands often, not touching your face, and wearing the provided gloves at all times during the time you are serving? Face shields are optional *

YES

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