Health Screening Questionnaire
All Tridonn Construction Co. employees, subcontractors, vendors, and visitors are required to take this questionnaire prior to physically entering any Tridonn Construction Co. job site. The questionnaire should be taken the same day that you intend to physically be on the job site. If you answer "Yes" to any question, you should contact your supervisor before accessing the job site. You are required to check in with the site supervisor before entering the job site to verify you have filled out the questionnaire.
Tridonn Construction Co. Project Name *
Your answer
Company Name *
Your answer
Name *
Last, First
Your answer
On what date will you be accessing this job site? *
MM
/
DD
/
YYYY
Have you experienced any flu-like symptoms in the last 14 days (to include fever, cough,sore throat, respiratory illness, difficulty breathing)? *
Has anyone in your household experienced any cold or flu-like symptoms in the last 14 days (to include fever, cough,sore throat, respiratory illness, difficulty breathing)? *
Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days? *
Have you traveled out of the country, out of the state, or to one of Michigan's coronavirus hotspots (City of Detroit, Macomb, Oakland, or Wayne Counties) within the last 14 days? *
If you have answered "Yes" to any of the questions above please give a short explanation for your answer. (Please exclude any names in your explanation)
Your answer
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