Community Health Attestation

To promote the safety of the community and reduce the impact of COVID-19, New Hampshire is requiring employers to comply with the daily monitoring of employees temperatures and the documenting of responses to 5 questions.

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* Your Name:

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* Does your temperature exceed 100.4 degrees Fahrenheit today?

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* Do you have any of the following symptoms of COVID-19:
(New symptoms not a preexisting condition):
  • Fever, or feeling feverish;
  • Respiratory symptoms such as runny nose, nasal congestion, sore throat, cough, or shortness of breath;
  • General body symptoms such as muscle aches, chills, and severe fatigue;
  • Gastrointestinal symptoms such as nausea, vomiting, or diarrhea;
  • Changes in a person’s sense of taste or smell

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* Have you had close contact with someone who is suspected or confirmed to have COVID-19 in the prior 14 days?

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* Have you traveled in the prior 14 days outside of New Hampshire, Vermont, Maine, Massachusetts, Connecticut, or Rhode Island?

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