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Please submit this checklist BEFORE meeting with a contractor/vendor.

If the answer is YES to a symptom in question #3 OR YES to two or more symptoms in question #4, and/or the contractor/vendor has a temperature of 100.4 or higher, please do not meet with them. Cancel the meeting and reschedule. Advise the contractor/vendor to self-isolate at home and to contact their primary care physician's office for direction. This survey must be completed for each contractor/vendor that will be participating in a meeting at one of our offices.  EXCEPTION for #6: If answered "yes", you may continue to meet with the client IF they have received the COVID-19 vaccine, and it has been at least 2 weeks since their final vaccine. Thank you.

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* 2. What is your name?

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* 3. Ask the contractor/vendor the following questions:
In the past 24 hours have you experienced any of the following symptoms not explained by a known medical or physical condition?

  No Yes
Fever
Uncontrolled cough
Shortness of breath

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* 4. In the past 24 hours have you experienced any TWO of the following symptoms not explained by a known medical or physical condition?

  No Yes
Loss of taste or smell
Muscle pain
Sore throat
Severe headache
Diarrhea
Vomiting
Abdominal

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* 5. Current temperature (##.#)

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* 6. Have you had close contact in the last 14 days with an individual diagnosed with COVID-19 ? (The CDC defines close contact as being within 6 feet of an infected person for 15 minutes or more.)

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* 7. Have you been directed or told by anyone to self-isolate or self-quarantine?

0 of 7 answered
 

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