COVID-19 Screening
If you answer yes to any of the following questions you may be required to self quarantine for up to 14 days.
Name *
Date *
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Phone number *
Which work location are you checking in to? *
In the last 10 days have you experienced any of the following symptoms: Fever or chills, cough, shortness of breath, fatigue, muscle or body ache, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, or diarrhea. *
Required
Have you had a positive COVID-19 test in the last 14 days? *
Required
Have you been designated as a "contact" of someone who tested positive for COVID-19 by a local health department and been placed on quarantine? OR Are there other individuals in your household who are symptomatic and are in the process of being tested for COVID-19? *
Required
In the last 14 days, have you been in another country or a state other than New Jersey, Connecticut, Pennsylvania, Massachusetts, or Vermont for more than 24 hours? *
In the last 14 days, have you been in another country or a state other than New Jersey, Connecticut, Pennsylvania, Massachusetts, or Vermont for more than 24 hours? *
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