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):
  • Respiratory symptoms such as a 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 your sense of taste or smell?

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

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* Have you traveled in the past 14 days either:
i. Internationally (outside the U.S.)

ii. By cruise ship
iii. Domestically (within the U.S.) outside of NH, VT, RI, CT, MA. Or ME (regardless of mode of transportation)

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