Staff Daily Covid 19 Questionnaire



    Please enter your employee number



    Please enter the telephone number at which you can be reached today if needed



    Please review the symptom checklist below

    Some symptoms may appear 2-14 days after exposure to the virus and most people do not experience all of the symptoms.

    If you have been exposed (witihin 6 feet for greater than 15 minutes) to a person with confirmed COVID in the past 14 days WITHOUT PROPER PPE, you are able to remain at work as long as you are not symptomatic.

    • Fever of greater than or equal to 100°F
    • Shortness of breath
    • Sore throat
    • Diarrhea, nausea, vomiting
    • Runny nose
    • Headache, fatigue, muscle aches
    • Nasal congestion
    • New loss of sense of smell and/or taste
    • New cough
    • Positive COVID test in past 10 days (not previously reported to EHS)

    Are you experiencing any of the above symptoms (unrelated to a known and/or chronic condition)?

    BY CLICKING SUBMIT, YOU ARE CONFIRMING THAT YOUR RESPONSES ABOVE ARE CORRECT