ALE/HUB COVID-19 Staff Self-Screening Form
Complete this form prior to entering. If your response to any question is "Yes", then notify your supervisor immediately.
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Email *
Last Name *
First Name *
Location *
Have you experienced ANY of the following symptoms; Unexplained Cough; Unexplained Difficulty Breathing; Unexplained Shortness of Breath; Unexplained Sore Throat; Unexplained Loss of Taste or Smell? *
Have you had close contact with an infected person (COVID-19) within the previous 14 days? *
Have you experienced a fever of 100.4 within the last 48 hours? *
Temperature *
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