COVID-19 Workplace Health Screening

In the last 14 days, have you developed any of the following symptoms that are new/different/worse from baseline of any chronic illness? *

YES

NO

New or worsening cough:

Shortness of breath or difficulty breathing

New loss of taste and/or smell

In the last 14 days, have you developed any of the following symptoms that are new/different/worse from baseline of any chronic illness? *

YES

NO

Subjective Fever or measured fever

Chills

Headache

Sore Throat

Runny nose or congestion

Muscle aches

Abdominal pain

Fatigue

Nausea

Vomiting

Diarrea

Current Temperature

If you answer YES to any of the symptoms listed in section 1, OR YES to two or more of the symptoms listed in section 2, OR if your temperature is 100.4f or higher, please do no go into work. Self-isolate at home and contact your primary care physician's office for direction.

-If your doctor does not recommend COVID testing, consult with your supervisor and follow the guidance from the Managing Communicable Disease in Schools document for return to work criteria.

- -If diagnosed as a probable COVID-19 or test positive, call your local health department and make them aware of your diagnosis or testing status.

You must also have gone 24 hours without a fever and improvement in symptoms

In the past 14 days, have you: *

YES

NO

Had close contact with an individual diagnosed with COVID-19?

Traveled internationally?

If you answer YES to any of the symptoms listed in section 1, OR YES to two or more of the symptoms listed in section 2, OR if your temperature is 100.4f or higher, please do no go into work. Self-isolate at home and contact your primary care physician's office for direction.

For questions, visit www.dhd4.org. Contact the District health department to ensure they are aware. Aug 5, 2020