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Daily Health Screening
Please complete the following form every day before coming to the building. If you have a temperature of 100.4 or higher or exhibit any of the following symptoms, we are asking that you stay home and contact Human Resources.
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Email
*
Your email
Last Name
*
Your answer
First Name
*
Your answer
Temperature
*
Your answer
Fever, Cough, Chills, and/or Muscle aches
*
Yes
No
Sore throat, runny nose, and/or loss of taste or smell
*
Yes
No
Nausea, vomiting, and/or diarrhea
*
Yes
No
Shortness of breath and/or headaches
*
Yes
No
Close contact, or cared for someone with COVID-19
*
Yes
No
A copy of your responses will be emailed to the address you provided.
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