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SwimJim COVID-19 Employee Health Questionnaire (DAILY)
Each employee must complete this questionnaire daily at the beginning of their scheduled shift.
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* Indicates required question
Email
*
Your email
Is your temperature above 100 degrees?
*
Yes
No
If "Yes" to the above question, how long has your temperature been above 100 degrees?
Your answer
Has anyone in your household tested positive for COVID-19 (coronavirus) in the past 2-14 days?
*
Yes
No
If the answer is "Yes" to the above question, what medical advice followed?
Your answer
Have you felt chest pains or tightness in the last 14 days?
*
Yes
No
If the answer is "Yes" to the above question, did you seek medical care, and what was the result?
Your answer
Have you had a consistent cough in the last 14 days?
*
Yes
No
If "Yes" to the above question, did you seek medical attention, and what was the result?
Your answer
Have you experienced body aches in the last 14 days?
*
Yes
No
If "Yes", to the above question, did you seek medical attention, and what was the result?
Your answer
To the best of your knowledge, in the last 14 days have you been in direct contact with someone who was confirmed to have COVID-19/coronavirus?
*
Yes
No
If "Yes" to the above question, did you self-quarantine or seek medical advice?
Yes
No
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