APS Health Screening
PRIOR to entering any building, staff MUST submit this form. If you have any questions or concerns, please contact the HR Department.

DISCLAIMER: This screening tool is subject to change based on the latest information on COVID-19.
Employee ID: *
Last Name *
First Name *
Building: *
Job Title *
In the last 14 days, have you developed ONE of the following symptoms that are new/different/worse from baseline of any chronic illness? *
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