COVID 19 Screen

Covid-19 Screening questions

  • Covid-19 Screening Protocol: Optional Survey for Employee Self-administration
  • MM slash DD slash YYYY
  • Yes, or No, Since your last day at work or your last visit to this establishment, have you had any of the following symptoms?
  • COVID-19 Optional Employee Agreement: Infection Control Practices during your time in this establishment. Do you agree to:
  • This field is for validation purposes and should be left unchanged.