COVID-19 Health Assessment Form
Workplace safety is our highest priority. To prevent the spread of COVID-19 and reduce the potential risk of exposure to our team members and visitors, we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measures to protect you and everyone in our facility.
This form must be completed before you enter the job site each day, until further notice. Any affirmative responses to the below questions must be reviewed immediately with your Supervisor. Do NOT enter the workplace if you have responded yes to any question until you are evaluated and receive further direction following CDC protocol.