Skip to content
Daily Self-Certification of Health & COVID Risk
This survey is required to be completed prior to entry in the office.
In our effort to limit the spread of COVID-19, you will be required to self-certify your health status and review your risk for exposure prior to entering the office.
*
1.
Your Name:
(Required.)
*
2.
In the past 14 days, have you or a member of your immediate household received a positive COVID-19 test?
(Required.)
No
Yes. You are not allowed to come into the office. Please contact HR.
