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.
In the past 24 hours, have you had any of the following NEW symptoms? (If any apply please contact your supervisor)
Fever of 100.3F or above, or possible fever symptoms like alternating chills and sweating
Trouble breathing, shortness of breath, or severe wheezing
Loss of smell or taste or a change in taste
Have you been within 6ft of a person with a lab-confirmed case of COVID-19 for at least 5 minutes or had direct contact with their mucus or saliva (in the past 14 days)? (If YES, please contact your supervisor)
Temperature (if greater than 100.3, please contact your supervisor):
Send me a copy of my responses.
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This form was created inside of Northwest Local Schools.