Employee Covid19 Check In Form First and Last Name * Email * Date * Dining Location * Cheney Hall Pride's Place Marketplace @ The Union Learning Commons Starbucks Work Shift * Do you have the following? * Mask Safety Shoes Hat Nametag Proper Uniform Cut Glove (culinary only) Thermometer (culinary only) Are you experiencing any of the following symptoms? * Fever Cough Shortness of Breath Sore Throat Diarrhea None of the above Have you had any close contact in the last 14 days with someone with a diagnosis of COVID-19? * Yes No Is your temperature above 100.3 degrees F. (your temp will be taken again upon arrival) * Yes No Have you traveled out of state (unless it was for your typical job commute) or internationally in the last 14 days? * Yes No If you have answered yes to any of the above questions, please consult with your manager before coming in to work. I agree After you submit this form you will receive a confirmation email. Please show this to the health check in manager upon arrival. I agree Submit