Healthy at Work Daily Health Check

  • Daily health check

    The 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.
  • This information will be used to route this form to your supervisor. If it is incorrect, your supervisor will not receive your form.
  • MM slash DD slash YYYY
  • Screening Questions

  • For the purposes of the pandemic, a fever is a temperature above 100.4 degrees.
  • "Yes" response

    If you answered “yes” to either screening question, you should contact your supervisor before coming to campus to discuss the situation.
  • If you would like a copy of this form emailed to you, please include your email address below.