UFCRS Daily Health Screening Survey
Welcome to the Union Fire Company & Rescue Squad. Thank you for volunteering to serve our neighbors. In order to provide a safe environment for all involved, please complete this short questionnaire just prior to your shift. The following information is required by Governor Murphy's Executive Order #192.
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What is your first & last name?
At what phone number may we contact you?
When you took your temperature, was it over 100.4 degrees?
Are you experiencing any of the following within the past 48 hours? (that is not a symptom that you normally experience)
Chills or Fever (temperature over 100.4)
Congestion or Runny Nose (not caused by allergies)
Cough or Shortness of Breath
Nausea or Vomiting
New Loss of Taste or Smell
If "Other" was selected above, please explain:
Have you recently lost your sense of taste or smell?
Within the past 14 days, have you had close contact with someone who has tested positive for COVID-19, without wearing PPE? (CDC Defines close contact as being within 6 feet of someone for greater than 15 minutes in a 24 hour period OR living in the same house as a COVID-19 positive person).
Have you attended a gathering of more than 10 people (indoors) or 25 people (outdoors) within the past 5 days?
Thank you. If you have answered YES to any of the above, or checked more than 2 symptoms, please do NOT enter the building or respond to a call. Please contact Doug Pszczolkowski (609) 751-1535 for help or clarification.
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