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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Email *
First Name *
Last Name *
Work Location: *
Have you had any of the following symptoms in the past 3 days? (Check all that apply) *
Required
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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