COVID-19 Employee Screening
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1.
Please enter your name.
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2.
Have you taken your temperature this morning? (If your answer is no, please go to an office immediately to have your temperature taken.)
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--Please Select--
Yes
No
3.
Have you experienced a fever of 100 degrees Fahrenheit or greater within the past 10 days?
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--Please Select--
Yes
No
4.
Have you experienced a new cough, gastrointestinal issues, new loss of taste or smell, or shortness of breath within the past 10 days that can not be attributed to another cause?
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--Please Select--
Yes
No
5.
In the past 10 days, have you tested positive for COVID-19 using a test that tested saliva or used a nose or throat swab (not a blood test)? (10 days measured from the date you were tested, not the date you received the test result
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--Please Select--
Yes
No
6.
To the best of your knowledge, in the past 14 days, have you been in close contact (within 6 feet for at least 10 minutes) with anyone while they had COVID-19?
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--Please Select--
Yes
No
7.
In the past 14 days, have you traveled internationally or returned from a state identified by New York State as having widespread community transmission of COVID-19 (other than just passing through the restricted state for less than 24 hours)? Visit https://coronavirus.health.ny.gov/covid-19-travel-advisory for applicable states.
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--Please Select--
Yes
No