Covid-19 Daily Health Check

Name (First, Last)*

Company Name*

Jobsite*

Select or enter value

Are you experiencing a fever, a headache, a cough, or shortness of breath?*

If "Yes" do not enter the jobsite and call your supervisor

Yes

No

Have you been in contact with anyone suspected of having Covid-19?*

If "Yes" do not enter the jobsite and call your supervisor

Yes

No

I understand the social distancing policy (6 feet of seperation)*

If "No" do not enter the jobsite and call your supervisor

Yes

No

Send me a copy of my responses