Check SCREEN READER MODE to make this survey compatible with screen readers.
STONETAPERT COVID-19 SCREENING QUESTIONNAIRE
The safety of our employees and their family members is our priority. As the coronavirus (COVID-19) pandemic continues, we are monitoring the situation closely and following the guidance from the Centers for Disease Control and Prevention and local health authorities. In order to prevent the spread of the coronavirus and reduce the potential risk of exposure to our workforce, we are asking everyone to complete and submit this questionnaire prior to entering the worksite.
Please respond to each of the following questions truthfully and to the best of your ability. Your participation is important to help us take precautionary measures to protect you and our other employees.
Do not enter the worksite if you respond “Yes” to any of the following questions and contact Joann Montanez at (626) 243-1444 for approval to enter.
Note: The information collected on this form will be used to determine whether you may be infected with COVID-19. The information on this form will be maintained as confidential. Any questions should be directed to the Office Manager or your direct supervisor.