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HHS Staff Daily Health Check Form
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* Indicates required question
Email
*
Your email
Last Name:
*
Your answer
First Name:
*
Your answer
Current body temperature:
*
Your answer
Do you have any of these symptoms:
cough
chills
fever
sore throat
can't smell
no taste
nausea
I have no symptoms
Do you have any family members or friends that exhibit any symptoms listed in the previous question?
*
Yes
No
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