As we continue to take measures to ensure a safe and healthy work environment during the COVID-19 pandemic, we ask that you carefully complete this self-assessment.

  1. 1Are you experiencing influenza or influenza-like symptoms that include one or all of the following?
    • Fever (100.4 degrees Fahrenheit or higher)
    • Chills
    • Cough
    • Shortness of breath or difficulty breathing
    • Fatigue
    • Muscle or body aches
    • Headache
    • New loss of taste or smell
    • Sore throat
    • Congestion or runny nose
    • Nausea or vomiting
    • Diarrhea
  2. 2 Within the last 14 days, to the best of your knowledge, have you been in close contact with a person who is currently being evaluated for COVID-19 or who has been diagnosed with the COVID-19 virus?
    Per CDC guidelines, “close contact“ is defined as being within six feet of someone for a duration of 15 minutes or greater.
  3. 3 Within the last 14 days, have you been advised to self-quarantine by a local or state health department or health care professional?

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By submitting this assessment, you are confirming that you have answered "No" to each of the above questions

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