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PLC Daily Health Screening
Please complete this form each day before arriving at PLC. If you answer "Yes" to any of the questions, please stay home. Thank you.
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Name
*
Your answer
Do you have a temperature greater than 100°F?
*
Yes
No
Did you take any medication to reduce a fever (e.g., ibuprofen, tylenol)?
*
Yes
No
Do you have any symptoms of fever, cough, or shortness of breath?
*
Yes
No
Are their members of your household who have any symptoms of fever, cough, or shortness of breath?
*
Yes
No
Have you had close contact with anyone who has been diagnosed with COVID-19 in the past 14 days?
*
Yes
No
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