This survey must be completed before arriving at work.

EMPLOYEE CERTIFICATION OF LACK OF EXPOSURE

Pursuant to Michigan Supreme Court Administrative Order 2020-14 issued May 6, 2020 and Wayne County Local Health Department Emergency Public Health Order #20-02 issued March 26, 2020 in response to the COVID-19 pandemic, and to help ensure your safety we ask that you complete this survey honestly and accurately. 

The purpose of this survey is to determine whether you or a visitor to or member of your household poses a heightened risk of exposing employees to the novel coronavirus/COVID-19 and therefore whether you will be allowed access to Wayne County Probate Court.

Please also note that this information will be kept confidential and will not be released to any third parties without your consent in writing.  Please also note that this information will be kept in your file marked confidential to only be seen by Human Resources and the Probate Court Pandemic Response Team.

Question Title

* 1. What is your name?

Question Title

* 2. Today's Date

Date

Question Title

* 3. Do you have a fever greater than 100.4 degrees?

0 of 9 answered
 

T