In accordance with the Leader Dog’s Return to Work plan, you are required to complete this form at the beginning of each shift. The information will be used to determine whether you might pose a heightened risk of transmitting COVID-19 such that you cannot currently work on campus.

Question Title

* 1. Name:

Question Title

* 2. I have one or more of the following symptoms (newly developed and not associated with a known medical condition):
  • a fever of 100.4 degrees or higher
  • chills
  • shortness of breath
  • cough
  • fatigue
  • muscle or body aches
  • headache
  • new loss of taste or smell
  • sore throat
  • congestion or runny nose
  • nausea or vomiting
  • diarrhea
I have had close contact with a confirmed/probable COVID-19 case in the last 5 days.

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