COVID-19 Daily Health Screening Form šŸ˜·
Please do not come to work / school If you have had symptoms consistent with COVID-19, have been exposed or have tested positive for COVID-19.

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Email address *
Full Name *
Employee Id *
Enter your current body temperature in Fahrenheit *
Employees should take their temperature before they go to work. If they have a temperature above 100.4F, they should stay home.
Are you feeling sick? *
In the last two weeks, did you have close contact with someone with symptoms of COVID-19, tested for COVID-19, or diagnosed with COVID-19? *
Close contact is when you are within 6 feet of an infected person for at least 15 minutes.
Do you have any of the following symptoms? *
Electronic Declaration *
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