Stay Safe Precaution Agreement
This health screening form MUST be completed for all volunteers no earlier than 12 hours before serving.

Anyone with signs of COVID symptoms, respiratory infection, fever above 100, and/or a productive cough within the last 12 hours are NOT allowed to serve for the safety of others as we try to prevent spread of potential virus.

In the interest of all volunteers and those we serve, we reserve the right to send you home if you do present any symptons upon arrival or answer yes to questions 1, 2, and 4 and no to 3 below.
Email address *
Name: *
Date *
1. In the last 24 hours, have you had any vomiting, diarrhea, fever, cough, sore throat or shortness of breath? *
2. In the last week, have you been sick or around anyone who has been sick? *
3. Have you traveled by air or been in close contact with anyone who has returned from air travel within the last 14 days? *
4. Do you agree to washing your hands often, not touching your face, and wearing the provided gloves at all times during the time you are serving? Face shields are optional *
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