Employee Covid19 Check In Form
Do you have the following? *
Are you experiencing any of the following symptoms? *
Have you had any close contact in the last 14 days with someone with a diagnosis of COVID-19? *
Is your temperature above 100.3 degrees F. (your temp will be taken again upon arrival) *
Have you traveled out of state (unless it was for your typical job commute) or internationally in the last 14 days? *
If you have answered yes to any of the above questions, please consult with your manager before coming in to work.
After you submit this form you will receive a confirmation email. Please show this to the health check in manager upon arrival.