COVID-19 Employee Self-Screen Assessment
The completion of the assessment is required daily at the start of the work day. The information submitted will remain confidential.
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First Name *
Last Name *
Please answer YES or NO
Since your last day of work, or since your last visit to this facility, have you had any of the following:
1. A new fever (100° or higher) or sense of having a fever? *
2. A new uncontrolled cough that you cannot attribute to another health condition? *
3. New shortness of breath that you cannot attribute to another health condition? *
4. A new sore throat that you cannot attribute to another health condition? *
5. Fatigue/new muscle aches that you cannot attribute to another health condition or that may have been caused by a specific activity (such as physical exercise)? *
6. New loss of taste or smell? *
7. Headache that you can not attribute to another health condition? *
8. Congestion/Runny Nose? *
9. Nausea/Vomiting, Diarrhea? *
10. To your knowledge, have you been exposed to anyone with COVID-19 in the past 10 days? Are you currently caring for someone in your household with COVID-19? *
If you answer "yes" to any of the previous questions, you are directed to leave the work site immediately AND contact your primary health care provider.
Please notify your direct supervisor via a phone call or email. Also, contact Kathy Lee for Classified staff at klee@cnusd.k12.ca.us or Ben Roberts for Certificated staff at broberts@cnusd.k12.ca.us to discuss any leave options available.
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