COVID-19 Screening: In Person and Face-to-Face Activities

Notice
Tennessen Notice: Prior to entering the office and beginning, “In-Person, Face-to-Face Activities,” all individuals will be asked a series of questions. This data is classified as private under the Minnesota Government Data Practices Act. We will use this data to screen individuals seeking access to MSED facilities for potential health risks to try to avoid the potential of spreading contagious diseases. The data helps us to determine whether risk factors are present and whether you will be denied access to the facility for the protection of our staff and/or the public. This is not a COVID-19 test and is not a determination of whether or not an individual is infected with or has been exposed to COVID-19. This data will be gathered and reviewed by designated staff, including non-medical personnel, in deciding whether you should be at the office or work from home. You are not legally required to provide this data and providing the data is voluntary. However, if you refuse to provide the data, you will not be permitted to work at any MSED facilities. The data collected from you may be shared with MSED staff collecting the data, District Office personnel, state and federal enforcement agencies, and any other persons or entities authorized by law.

Screening helps slow the spread of COVID-19 in our community while enabling a safe workplace. All individuals participating in, “In-Person, Face-to-Face Activities,” where social distancing measures are difficult to implement/sustain are required to complete “On-Site/Day-Of” screening. Screening must be completed prior to entering the MSED facility. The following questions must be answered.

Question Title

* 1. Your First and Last Name:

Question Title

* 2. Today's Date:

Date

Question Title

* 3. My work location today

Question Title

* 4. In the past 14 days, have you had close contact with a person who has been diagnosed with COVID-19 or displayed symptoms of COVID-19 while that person was ill?

Question Title

* 5. In the past 14 days, have you been told by a healthcare provider that you may have been exposed to COVID-19?

Question Title

* 6. Do You have any of the following symptoms:

  Yes No
Cough
Shortness of breath or difficulty breathing
Headache
Sore throat
New loss of taste or smell
Diarrhea
Symptoms of a fever such as chills, repeated shaking with chills, muscle aches/pain and/or weakness?

Question Title

* 7. Have you been to any known hot-spots (COVID-19 breakout areas) without taking the proper, recommended precautions?

Question Title

* 8. If all above questions are answered "NO," you may enter the MSED Facility. You must wash your hands on arrival and often throughout the day.

Follow all COVID-19 Preparedness Plan and CDC guidelines while at work.

If you feel sick, please tell the District Office, your Supervisor, Nurses Office and go home.

I certify that all of the above answers and statements are true and accurate by entering my initials below.

If ANY ABOVE QUESTION is answered "yes", you may not be permitted to enter the MSED facility and will need to contact the COVID-19 Coordinator Becky Dunaisky or Simoine if Becky is not available.
If they determine you are not permitted to enter the facility, you may be asked to leave and stay home until:
1. You have no fever for at least 24 hours (without the use of fever reducing medications), AND
2. Other symptoms have improved, AND
3. At least 10 days have passed since your symptoms first appeared.
0 of 8 answered
 

T