Employee Notification and Exposure Screening
On March 11, 2020, the World Health Organization declared the Coronavirus Disease 2019 (COVID-19) to be a global pandemic and, on March 13, 2020, the President of the United States declared a national emergency with respect to this dangerous virus. On March 6, 2020, the Governor of the State of Indiana declared a public health emergency within Indiana. To reduce and slow the spread of COVID-19, the Centers for Disease Control and Prevention and the Indiana State Department of Health recommend implementation of mitigation strategies, which will be implemented and enforced by the School Corporation, including, but not limited to:

-Frequent hand washing using soap and warm water for at least 20 seconds
-If soap and water aren’t available, using a hand sanitizer that contains at least 60% alcohol.
-Coughing and sneezing into elbows or a tissue/handkerchief
-Avoid touching eyes, nose, and mouth with unwashed hands.
-Self-quarantine at home as much as possible
-Maintain physical distance between yourself and other people of at least 6 feet at all times
-Do not use other employees’ phones, electronic devices, or other office supplies
-Cover mouth and nose with a cloth face cover while around others
-The cloth face covering is meant to protect other people in case you are infected
-Do not place face coverings on children under age 2, anyone with trouble breathing, or unable to remove the
mask without assistance

Failure to follow these mitigation strategies, to the extent possible in the workplace, will result in discipline, up to and including termination of employment/cancellation of contract. While these mitigation measures will likely reduce the spread of COVID-19 in our facilities, we cannot guarantee that you (or anyone you come into contact with) will not be, or otherwise, become infected with COVID-19.

We request that you complete this questionnaire, which will be solely used to determine whether health and safety restrictions should be implemented with respect to your presence at our facilities, and such information will be otherwise maintained as confidential.
Email *
Select Your Work Location *
Legal Last Name *
Legal First Name *
Cell Phone (Include Area Code): *
Have you recently been within 6 feet of a person with a lab-confirmed case of COVID-19, or a person who has exhibited multiple COVID-19 Symptoms in the last 14 days? *
Next
Never submit passwords through Google Forms.
This form was created inside of MSD of Wayne Township. Report Abuse