Northwest COVID-19 Employee Self Assessment
- This tool will help you perform a self-assessment to determine if you are clear to report to work and is based on CDC and ODH guidelines.
- Each employee MUST take the assessment each day before reporting to work.
- Masks are required when onsite, especially in public/common areas or areas that are not your private work space, the exception is if you are medically unable to wear a mask.
- Employees are asked to sanitize their work areas throughout the day and before leaving.

More info: https://coronavirus.ohio.gov/
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Email *
First Name: *
Last Name: *
Today's Date: *
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In the past 24 hours, have you had any of the following NEW symptoms? If you have checked any of these questions, DO NOT report to work and notify your building principal and school nurse).
Do any of the following pertain to you? If you have checked any of these questions, DO NOT report to work and notify your building principal and school nurse.
Temperature (if greater than 100, please return home and contact your supervisor): *
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