GWSD Staff Daily Health Screening (2020-21)
Please complete the following form daily before reporting to work. Dates are automatically recorded.
Do not come to work if you have a fever of 100.4 or higher, or if you are exhibiting any symptoms of COVID-19.
First Name *
Last Name *
Where to you work? *
Time of Temperature Check & Self Monitoring *
Time
:
What is your temperature? *
Do you have any of the following symptoms? *
Required
Comments or Notes
Submit
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