EFR COVID-19 Workplace Health Screening
All staff providing direct service or coming into the EFR office are expected to complete this form each day prior to service delivery or upon arrival to the EFR office.  Please note, if you answer "yes" to any of the questions below, or your temperature is 100*F or higher, you will not be able to work.  Please self-isolate at home and contact your primary care physician for direction.  You should also contact your supervisor at EFR to notify them.  

Per EFR Policy, you cannot return to work until:
--You have had no fever for at least 72 hours, without taking medication to reduce the fever

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Employee First and Last Name *
Location you are working *
Required
In the past 24 hours, have you experienced the following: *
Yes
No
A fever or felt like you had a fever
New or worsening cough
New or worsening shortness of breath?
Is your current temperature 100 degrees Fahrenheit or more? *
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