Covid-19 Daily Health Check
Each employee shall complete this questionnaire prior to working onsite.
Name (First, Last)
*
Company Name
*
Jobsite
*
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
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