Employee Symptoms Questionnaire
This form must be completed if you are experiencing symptoms consistent with COVID. Please take your temperature before leaving your household. If you are sick, please post your absence, notify your supervisor, and stay home. Thank you.
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Have you had any of the following symptoms in the past 3 days? (Check all that apply)
Fever 100.4 F or above
New shortness of breath
New loss of taste and or smell
New muscle aches
Congestion or runny nose
No, I have not had any of the symptoms above in the past 3 days.
Within the last 14 days, have you been exposed to a person infected with COVID-19? (Exposed- within 6 feet of the infected person for more than 15 minutes or unprotected contact with the infected person’s body fluids and/or secretions, for example, being coughed or sneezed on.)
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This form was created inside of South Whittier School District.