Kia of Cleveland COVID-19 Workday Questionnaire
Employee Name *
Department *
Required
Are you, any member of your household, or anyone you have been exposed to currently or anytime in the past 14 days suffering any of the following symptoms: Cough, fever above 100.4, shortness of breath? *
Required
Have you, any member of your household, or anyone you have been exposed to or had contact with anyone who has tested positive for COVID-19 within the last 14 days? *
Required
Are you or any member of your household qualified for a COVID-19 test and are waiting for the test or the results? *
Required
Have you or any member of your household or anyone you have been exposed to tested positive to COVID-19? *
Required
Have you traveled outside your home state of Tn in the past 14 days, besides to XXXX to work. *
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of Langdale Ford. Report Abuse