Healthy at Work Daily Health Check Daily health checkThe College is using self-administered health checks for unvaccinated employees working on campus. Please complete this form at the beginning of every day that you work on campus.Employee name*Supervisor's email address*This information will be used to route this form to your supervisor. If it is incorrect, your supervisor will not receive your form. Date* MM slash DD slash YYYY Screening QuestionsSince your last day on campus, have you had any of the following COVID-19 symptoms that are new or unexplained: fever or chills, cough, shortness of breath or breathing difficulty, fatigue, muscle or body aches, headache, loss or taste or smell, sore throat, congestion or runny nose, nausea or vomiting, or diarrhea?*For the purposes of the pandemic, a fever is a temperature above 100.4 degrees. Yes No Have you been in close contact with anyone exhibiting new or unexplained symptoms of COVID-19 (listed above) or who has been diagnosed with COVID-19?* Yes No "Yes" responseIf you answered “yes” to either screening question, you should contact your supervisor before coming to campus to discuss the situation.Confirmation* I confirm the above information is true and accurate to the best of my knowledge.Optional: EmailIf you would like a copy of this form emailed to you, please include your email address below.
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