Contractor Health Check-In Form

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All contractors working at ALCS are required to use this virtual screening tool every day within the first 30 minutes of your start time. This allows the District to evaluate for COVID-19 symptoms and/or for confirmed or potential exposure to a case of COVID-19.
For more information, visit www.alcsny.org

The Daily Health Check-In is an important component of ALCS' Health and Safety Guidelines, and your honest, dedicated participation is crucial.
Thank you for doing your part to protect yourself and the community.
Together, we are stopping the spread.

Name *

Phone number *

Company *

Have you experienced any of these symptoms in the past 10 days (not related to chronic, known conditions or seasonal allergies)? Cough; shortness or breath or difficulty breathing; fever (temperature of greater than 100.3 degrees F in the last 14 days); chills; repeated shaking with chills; muscle or body aches; headache; sore throat; new loss of taste or smell; congestion or runny nose; nausea or vomitting; diarrhea. *

Yes

Have you had a positive COVID-19 viral test result in the past 10 days? *

Yes

In taking your temperature today, was your temperature over 100.3 degrees F? *

Yes

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