COVID-19 RETURN TO WORK QUESTIONNAIRE

Employees are to self-isolate or quarantine to prevent the spread of infectious diseases, including COVID-19, and reduce the potential risk of exposure to our workforce, clients, and visitors. To return to work the CDC has provided clear guidance on what needs to occur before leaving isolation. Please do not attempt to return to work if you are not feeling well.
Have you been vaccinated for COVID-19? *
Have you submitted your vaccination card to Human Resources?

SELF DECLARATION

Please select the appropriate resonse below which currently apply to you.

Were you off due to an illness or did you develop any symptoms?
 +
If yes, did you have any of the following symptoms?
Check all that apply *
 
Were you tested for COVID-19? *
If yes, was the test positive?

Have you been isolated for at least ten (10) days since the onset of symptoms? 
Have your symptoms resolved or are markedly improved? (coughing has stopped or has considerably decreased from the onset of symptoms)
Have you been fever free for 24 hours (without the use of fever reducing medication)?
Have you been vomit free / diarrhea free for 24 hours?