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RiverStone Health Screening Form
Please complete each work day prior to coming to work. Questions? Call Employee Health: 406-651-6472
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Last Name
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Your answer
First Name
*
Your answer
Within the past 10 days have you been in close contact (within 6 feet for more than 15 cumulative minutes in a 24 hours period) with anyone diagnosed with COVID-19?
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Yes
No
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