Should you go to work?
A screening questionnaire for CareGivers America employees during the COVID-19 Crisis

Before staff provide care for an individual in the home, they should ask themselves, these questions...
Email address *
1. Do I have a fever (Higher than 100.3 degrees)? *
Do I have new respiratory symptoms such as cough, shortness of breath, or sore throat? *
Have I travelled to a COVID-19-Warning Level 3 (outside of U.S.) in the past 14 days? *
Have I had close contact with a person diagnosed with COVID-19 in the past 14 days? *
Have I been diagnosed with COVID-19? *
Have I been told by a health care provider that I may have COVID-19? *
CareGiver Name (First Name and Last Name) *
Your answer
CareGivers America Office Location (by city) *
CareGiver Phone Number *
Your answer
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