COVID-19 Health Screening
This pre-work Symptom Survey must be completed prior to reporting to work today. It is critically important that everyone working is healthy and symptom free. Please complete this brief survey.
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Restaurant Location
*
Are you currently experiencing any of these symptoms or have you experienced any of these symptoms in the last 24 hours? **If you answer yes to any of these questions, please speak with your Manager.
Nausea
*
Yes
No
Vomiting/Diarrhea
*
Yes
No
Fever (100F or higher)
*
Yes
No
Cough (not related to allergies)
*
Yes
No
Abdominal Cramps
*
Yes
No
Shortness of Breath
*
Yes
No
Have you recently been tested for COVID-19 and are awaiting results?
*
Yes
No
Have you been in close contact with someone with a confirmed diagnosis of COVID-19 or is being tested for COVID-19?
*
Yes
No
Signature
Submit
Should be Empty: