All responses are confidential and submitted directly to Kate Hildebrandt

e: kroth@leojroth.com
c: 585.261.1876

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* 1. Good Morning! How are you feeling today?

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* 2. Do you, or anyone you're working with, have any of the following symptoms?

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* 3. Do you have a fever?

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* 4. Have you, or anyone you're working with, traveled or done anything outside of your normal routine?

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* 5. Have you, or anyone you're working with, been exposed to someone being treated for COVID-19 or who has symptoms compatible with COVID-19?

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* 6. Do you need any additional PPE (Mask, Gloves, Sanitizer, Etc.)?

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* 7. Name (Foreman - Please list everyone onsite with you as well)

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* 8. Has anyone on your site called in sick today?

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* 9. Job Site

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* 10. Anything else we can help out with?

0 of 10 answered
 

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