Staff Daily Covid 19 Questionnaire



    Please enter your employee number



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


    Are you currently experiencing any of the following?

    Fever of 100 degrees F, a new cough not related to chronic condition, a sore throat, a new loss of taste or smell, a new shortness of breath or difficulty breathing, nausea, vomiting or diarrhea.



    Have you had a POSTIVE COVID -19 test in the past 10 days?
    (If you have already notified EHS of this exposure, please respond NO)




    Have you been within 6 feet for more than 10 minutes with a confirmed or suspected COVID – 19 case in the past 24 hours WITHOUT PROPER PPE?




    Have you traveled internationally? (If yes, After arrival in the U.S., travelers must either quarantine for 7 days with a test 3-5 days after travel, or quarantine for the full 10 days without a test.)



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