Submit this checklist each day BEFORE you enter an office/location, home visit, or off site meeting.

If you answer YES to a symptom in question #3 or YES to two or more symptoms in question #4, and/or have a temperature of 100.4 or higher, please do not go to work and DO NOT ENTER the building or meet with clients. Please contact your supervisor, self-isolate at home and contact your primary care physician's office for direction.  Thank you.

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* 2. What is your name?

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* 3. In the past 24 hours have you experienced any of the following symptoms not explained by a known medical or physical condition?

  No Yes
Fever
Uncontrolled cough
Shortness of breath

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* 4. In the past 24 hours have you experienced any TWO of the following symptoms not explained by a known medical or physical condition?

  No Yes
Loss of taste or smell
Muscle pain
Sore throat
Severe headache
Diarrhea
Vomiting
Abdominal pain

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* 5. Current temperature (##.#)

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* 6. Have you had close contact in the last 14 days with an individual diagnosed with COVID-19?  (The CDC defines close contact as someone who was within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24 hour period starting from 2 days before illness onset or for asymptomatic patients, 2 days prior to test specimen collection).

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* 7. Have you been directed or told by anyone to self-isolate or self-quarantine?

If you answer "yes" to question #6 or #7, please do not go in to work.  Contact your supervisor and self-quarantine at home for 14 days.  EXCEPTION for #6:  You may continue to work IF you have received the COVID-19 vaccine, and it has been at least 2 weeks since your final vaccine.
If you test positive for COVID-19: you should isolate at home for a minimum of 10 days since symptoms first appeared.  You must not have experienced a fever without the use of fever reducing medications for 24 hours and had an improvement of other symptoms prior to returning to work.
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