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ERS COVID-19 Screening
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Name
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Choose
Michael Furtado
Ethan Gilson
Alex Kennedy
Paul Lewkowicz
Steven Manifold
Jobsite
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Your answer
Temperature
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Your answer
COVID-19 symptoms:
• fever or chills
• cough
• shortness of breath or difficulty breathing
• fatigue
• muscle or body aches
• headache
• new loss of taste or smell
• sore throat
• congestion or runny nose
• nausea or vomiting
• diarrhea
Have you experienced any of the symptoms above in the past 48 hours:
*
Yes
No
Within the past 14 days, have you been in close physical contact (6 feet or closer for at least 15 minutes) with a person who is known to have laboratory-confirmedCOVID-19 or with anyone who has any symptoms consistent with COVID-19?
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Yes
No
Are you isolating or quarantining because you may have been exposed to a person withCOVID-19 or are worried that you may be sick with COVID-19?
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Yes
No
Are you currently waiting on the results of a COVID-19 test?
*
Yes
No
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