Coronavirus (COVID-19) Screening Question Title 1. Employee ID Question Title 2. Within the last 14 days, have you been in close contact with any person who has a confirmed case of Coronavirus (COVID-19)? Yes No Question Title 3. Within the last 14 days, have you been in close contact with any person who is suspected of having Coronavirus (COVID-19)? Yes No Question Title 4. Do you have any of the following symptoms: FEVER, COUGH, DIFFICULTY BREATHING, or SORE THROAT Yes No By entering your Employee Identification number, you hereby confirm to the best of your knowledge that you are not infected with the Coronavirus (COVID-19). If you are having any of the symptoms above, have been diagnosed as having Coronavirus (COVID-19) or have reason to believe that you have been in contact with someone that is infected, do not come to work! Instead contact your shift manager. 100% of survey complete. Done
