Employee Health Status Verification for a Safe Workplace Environment
If you experience any symptoms,you must immediately
contact your health care professional for recommended next steps AND notify your supervisor.
Employee Health Status for:
Your Project Manager:
Amanda Brown
Chris Adams
Darden Whitaker
James Walker
James Williams
Julie Frazee
Tony Meyers
Troy Crigler
Symptoms in the Last 24 Hours
Coughing
Yes
No
Shortness of breath
or
difficulty breathing
Yes
No
Fever
(usually 100.4 or higher)
Yes
No
Chills
Yes
No
Muscle pain
Yes
No
Headache
Yes
No
Sore throat
Yes
No
New loss of taste or smell
Yes
No
Symptoms in the Last 14 Days
Been in contact with someone who was
diagnosed
with COVID-19?
Yes
No
Been in close contact with someone who had
COVID-19
symptoms
?
Yes
No
Traveled internationally
or taken a cruise?
Yes
No
If you answered "Yes" to any part of question two:
Please DO NOT come into work.
You should self-quarantine for at least 14 days.