COVID-19 Questionnaire

Please tell us how you are feeling today, and please note that coming to work while sick with symptoms of COVID-19 is not permitted.

Have you been fully vaccinated for COVID-19? *required
For the purposes of this guidance, people are considered fully vaccinated for COVID-19 ≥2 weeks after they have received the second dose in a 2-dose series (Pfizer-BioNTech or Moderna), or ≥2 weeks after they have received a single-dose vaccine (Johnson and Johnson [J&J]/Janssen. Yes No

1. Have you tested positive for COVID-19 in the past 14 days? *required Yes No

2. Do you have any of the following symptoms – fever above 100.4 degrees Fahrenheit, persistent dry cough, shortness of breath/difficulty breathing, chills or repeated shaking with chills, new loss of taste or sense of smell, flu-like muscle pain, sore throat and headaches? *required Yes No

3. In the last 14 days, have you been in close or proximate contact with any individuals suffering from COVID-19 symptoms? *required Yes No

4. Are you currently under quarantine or isolation orders? *required Yes No

- fever above 100.4 degrees Fahrenheit

- persistent dry cough, shortness of breath/difficulty breathing

- chills or repeated shaking with chills

- new loss of taste or sense of smell

- flu-like muscle pain

- sore throat and headaches
By clicking “submit,” you certify that the answers you provided to the above questions are true and accurate to the best of your knowledge and belief, at this time.