2020-2021 Leigh Daily COVID-19 Symptom Check - Staff
In response to the COVID-19 pandemic and in accordance with guidance issued by local and state public health officials, all staff must be screened for COVID-19 symptoms. These symptoms include fever, chills, cough, shortness of breath, difficulty breathing, fatigue, muscle or body aches, headache, recent loss of taste or smell, sore throat, congestion or runny nose, nausea, vomiting, and diarrhea. If you have any questions regarding your health, please contact your medical provider for information. This information will remain confidential.
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First Name *
Last Name *
Today's Date
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Within the last 14 days have you been diagnosed with COVID-19 or had a test confirming you had the virus? *
Do you live in the same household with, or have you had close contact with, someone in the past 14 days has been in isolation for COVID-19 or had a test confirming they have the virus? Close contact is less than 6 feet for 15 minutes or more. *
Have you had any one or more of these symptoms today or within the past 24 hours?   Please check the boxes below if the symptom is new or not explained by another reason. *
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If you are monitoring your temperature, please indicate your temperature (not required)
Please initial below to confirm that the above information is accurate to the best of your knowledge. *
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