EMPLOYEE HEALTH SELF-SCREENING
The safety and health of employees is best achieved through personal responsibility for your actions. The following questions must be answered each day that you report to work at a district facility.
Email address *
Today's Date *
MM
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DD
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YYYY
Name *
Site/Department *
Are you experiencing any of the following as NEW, UNEXPLAINABLE symptoms?
If you have any of the following, DO NO REPORT PHYSICALLY TO WORK AND NOTIFY YOUR SUPERVISOR:
Fever (>100.0) *
Cough? *
Shortness of breath or difficulty breathing *
Chills? *
Repeated shaking with chills? *
Muscle pain? *
Headache? *
Sore throat? *
New loss of taste or smell? *
Diarrhea? *
Nausea or vomiting? *
Congestion or runny nose? *
Fatigue? *
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