COVID-19 Health Screening
Please read each question carefully. 
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Name
Date of Screen
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Have you experienced any of the symptoms in the list below in the past 48 hours?
 
- Fever or chills
New or unexplained onset of cough, shortness of breath, or difficulty breathing
New or unexplained loss of taste or smell
- New or unexplained muscle aches
This symptom list is not exhaustive of possible symptoms of COVID-19; it was developed using a scientific approach by CDC scientists who reviewed the literature and studies to determine which symptoms are most predictive of COVID-19.  If you have had any of these symptoms in the last 48 hours, DO NOT physically return to TREE House of Greater St. Louis until symptoms have been improving for more than 48 hours. 
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Are you isolating because you tested positive for COVID-19 or are sick and suspect that you have COVID-19 but do not yet have test results? 
Regardless of vaccination status, you should isolate from others when you have COVID-19. You should also isolate if you are sick and suspect that you have COVID-19 but do not yet have test results.
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Have you been exposed to the virus that causes COVID-19 in the last 10 days?  
If you were exposed to the virus that causes COVID-19 or have been told by a healthcare provider or public health authority that you were exposed, get tested at least 5 full days after your last exposure.
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Did you have a negative COVID-19 test result from a test taken 5 full days after your last exposure to the person who tested positive for COVID-19?  (If it hasn't yet been 5 full days since your last exposure, select "Yes".)
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Regardless of your vaccination status, 

If you have answered any questions as Access Not Approved, you are NOT CLEARED and you must return home immediately if you are on the TREE House Campus, contact your health care provider for medical guidance, and contact your supervisor/TREE House of Greater St. Louis to discuss any next steps once you take care of yourself/your family.

If you have any doubt whether or not you are feeling sick, whether you think it is allergies, a cold, or something else, please stay home.

Please select the appropriate selection to affirm the screening of each individual and final access approval.
*
Name of the person completing and affirming the assessment and access approval below. *
You have indicated your understanding and have agreed to follow all health/safety protocols of TREE House of Greater St. Louis, which may include but is not limited to wearing FACE COVERINGS and practicing SOCIAL DISTANCING, per applicable current CDC guidance.   

The current Community Transmission Level for St. Charles County, MO is HIGH.  The CDC provides Transmission Levels (also known as Community Transmission) to describe the amount of COVID-19 spread within each county. Healthcare facilities use Transmission Levels to determine infection control interventions.

STAY INFORMED
All employees/volunteers/participants/visitors are expected to stay informed and seek current information from reputable sources such as the St. Charles County COVID-19 website, the Centers for Disease Control and Prevention ), the Missouri Department of Health and Senior Services or the World Health Organization.

For questions about COVID-19, please call the St. Charles County Health Department at 636-949-1899, the State of Missouri Department of Health & Senior Services at 877-435-8411, or the Centers for Disease Control and Prevention at 1-800-232-4636.  Please consult your medical provider for all medical questions.  For medical emergencies, dial 911.

Please enter the name of the person completing and affirming the assessment and access approval below.
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