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Workplace Safety Checkup

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:

Symptoms in the Last 24 Hours
Shortness of breath
or difficulty breathing
(usually 100.4 or higher)
Muscle pain
Sore throat
New loss of taste or smell
Symptoms in the Last 14 Days
Been in contact with someone who was diagnosed
with COVID-19?
Been in close contact with someone who had
COVID-19 symptoms?
Traveled internationally
or taken a cruise?
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.