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Employee Daily Screener
Date
MM
/
DD
/
YYYY
Employee's First Name
Employee's Last Name
Section One: Symptoms (Check all that apply) *
Required
Section Two: Close Contact/Potential Exposure (Check all that apply) *
Required
Please follow these guidelines for if you answered YES to any of these questions:
Staff working in school with the following symptoms (new/different/worse from baseline of any chronic illness) should be excluded from work and encouraged to follow up with their health care provider. This includes ONE of the following: feverish, new cough, shortness of breath or TWO of the following: chills, headache, sore throat, loss of smell or taste, congestion, muscle aches, abdominal pain, fatigue, nausea, vomiting, diarrhea. Staff may return to work when: 1. Their symptoms improve, AND 2. They have been fever-free for at least 24 hours without fever-reducing medication, AND 3. Any of the following apply: Another cause is identified for symptoms by a healthcare provider, OR You test negative for COVID-19 with a diagnostic test, OR At least 10 days have passed since symptoms first appeared ALSO, staff who are close contacts to someone diagnosed with COVID19 should be excluded for 14 days after last contact, and staff with a history of travel to places with high rates of COVID-19 may be excluded based on employer policy.
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