You may have been exposed to COVID-19 on your travels (domestic and/or international) and/or vacation. You may feel well and not have any symptoms, but you can be contagious without symptoms and spread the virus to others. To ensure continuity of operations of essential functions, the CDC advises, regardless of where you traveled or what you did during your trip, take these actions to protect others from getting sick:



Employees must take their temperature and assess symptoms prior to them starting work. Temperature checks should happen before the individual enters the facility.



As long as the employee doesn’t have a temperature or symptoms, they should self-monitor.

Employees must self-monitor to ensure no fever or symptoms have started to develop. If an employee starts to feel ill or develop any symptoms of illness (e.g. fever, cough, shortness of breath, upset stomach, headache, congestion, etc.) they are not to report to work. If symptoms develop at work, they are immediately required to leave the workplace and notify their supervisor and HR.



The employee MUST wear a face mask at all times while in the workplace.

Employees may use cloth face coverings in the event of shortages.



The employee MUST maintain a minimum of 6 feet and practice social distancing in the workplace at all times.



Employees should clean and disinfect all areas such as offices, bathrooms, common areas, shared equipment routinely. All glasses/goggles must be disinfected after use. Do not share PPE supplies.

If the employee becomes sick during the day, they should go home immediately.


Contact Human Resources at 800-249-6161 or regarding any changes or questions.


I agree to take my temperature prior to my shift and will notify HR by calling 800-249-6161 or
emailing if my temperature is 100 degrees farenheit or higher. *
I agree to wear a face covering at all times when I am working - this may be one supplied by MJS or a cloth face covering in the event of a shortage. *
I agree to maintain 6 foot minimum social distancing from coworkers and client workers at all times. *
I agree to disinfect and clean my workspaces and equipment regularly and will not share PPE with anyone. *
I agree to monitor my symptoms at all times. *
I agree to not report to work or to leave work immediately if I begin to feel unwell or develop symptoms of any kind. *
I agree to notify HR immediately by calling 800-249-6161 or emailing if I develop symptoms and I will provide information on the specific symptoms, when these symptoms started and who I may have exposed. *


I agree that the information I am providing is true and accurate to the best of my knowledge.

Signature: *