Stillman FPD Pre-Shift Screening
Name *
Your answer
Date of Shift *
MM
/
DD
/
YYYY
Do you have common symptoms of COVID-19 : Cough (New or Worsening), sore throat, shortness of breath, or a tempature above 100.4 degrees F? *
Have you taken any fever-reducing medications withing the last 24 hours for a fever? *
Since you last worked/responded, has someone in your household been diagnosed with COVID-19 *
What is your current tempature? *
Your answer
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