Covid-19 Daily Questionnaire
Everyone must complete this questionnaire prior to entering the Green Stem Provisioning facility for the first time (each day).
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Full Name *
Today's Date: *
MM
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DD
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YYYY
What is your current temperature? * Thermometers located in breakroom & reception* *
Have you had any signs or symptoms of a fever in the past 24 hours such as chills, sweats, felt "feverish" or had a temperature that is elevated for you/100.0F or greater? *
Do you have any of the following symptoms? Cough, Shortness of Breath, Chest Tightness, Sore Throat, Nasal Congestion, Runny Nose, Body Aches, Loss of Taste and/or Smell, Diarrhea, Nausea, Vomiting, Fever, Chills, Sweats? *
Have you had any close contact in the last 14 days with someone with a diagnosis of COVID-19? *
If you answered "Yes" to any of the questions above, you may have an elevated risk of Covid-19. Do not enter the Green Stem facility. Call your manager to discuss Covid-19 screening options before you return to work. * *
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