CCFD Daily Employee Screening
INTENT: To provide early detection of COVID-19 infection and to prevent potentially infected employees from entering the workplace and thus reduce the risk of exposure to co-workers and the community. This form also meets the intent of SMCO Health Guidelines for General Employee Health Monitoring, and also for Self-Monitoring and Self-Monitoring with Delegated Supervision after Low Risk Exposures.

INSTRUCTIONS:
• Measure your temperature and consider the presence of any symptoms twice per day, every day (morning and evening, on and off duty).

• Measure your temperature and any symptoms before leaving home to report for work. This pre-work screening will be considered one of the twice daily screenings.

• If you develop a fever greater than 100.0*F or any symptoms, immediately self-isolate and notify the Duty Battalion Chief.

• Persistent Cough
• Body Aches
• Shortness of Breath, unrelieved with rest.
• Chills
• Loss of taste or smell
• Unexplained gastrointestinal disturbance (nausea, vomiting, abdominal pain or diarrhea)

• Recorded each screening on a CCFD Daily Employee Screening Form.

Enter department email to identify yourself. Upon completion, you will receive a confirmation email.
Email address *
Date of screening *
MM
/
DD
/
YYYY
Time of Day: *
Select Apparatus, Division, or Off Duty
Temp (*F): *
Your answer
Select any symptoms that you are experiencing: *
Required
Submit
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