Health Screening COVID-19
ALL EMPLOYEES: Please complete this form daily prior to each work shift. If you answer YES to any question OR have a temperature of 100.1 or more, please do not report to work and contact Alex at 617-642-8088.
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Employee Name *
Do you have a fever or have you had a fever in the past 24 hours (100.0 degrees or more)? *
Are you experiencing any respiratory symptoms including a runny nose, sore throat, cough, or shortness of breath? *
Are you experiencing any new muscle aches or chills? *
Any new changes to your sense of smell or tastes? *
Have you been exposed to anyone who has tested positive for COVID-19 in the past 14 days? *
What is your current temperature? *
Date and Time *
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