• Please enter your name and clock number

    If you are Salary type "Salary" in the Clock Number box
  • In the past 14 days, have you:

  • Tested positive for COVID-19, or been in contact with anyone suspected or confirmed to have COVID-19?*
  • Traveled internationally?*
  • Do you understand that:

  • ·Do you understand that the virus may be spread by contact with surfaces or through the air?

    ·Do you understand that people over the age of 60 and those with underlying health conditions, including respiratory illness, heart disease, hypertension, diabetes and those immunocompromised are at risk of more severe illness or even death if they are infected with the COVID-19 virus?

    ·Do you understand the new safety protocols that have been implemented?

    ·Do you understand that providing false information or a failure to comply with state and county orders may result in disciplinary action up to and including termination?

    ·Do you understand that the image below displays the only proper way to wear a mask?

  • Do you understand:*
  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  • COVID-19 Symptom Screening Form:

  • In the past 24 hours, have you experienced any of the following symptoms that are not attributed to a known medical reason?:*
    • Subjective fever(Felt feverish or chills)
    • Muscle or body aches
    • Runny nose or congestion
    • Nausea or vomiting
    • Fatigue
    • Headache
    • New loss of taste or smell
    • Cough
    • Shortness of breath or difficulties breathing
    • Sore throat
    • Diarrhea
  • Please hit "Submit" below to get your checkmark to show the attendant

  • Show the attendant when asked during the entrance process that you are showing symptoms OR stay at home and call the Attendance Hotline and inform them

    Show the attendant when asked during the entrance process that you are showing symptoms OR stay at home and call the Attendance Hotline and inform them

    Attendance Hotline #: 1 (888) 378-8407
  • Please Hit Submit After Calling In OR Talking To The Attendant
  • Show the attendant when asked during the entrance process that you have been exposed OR stay at home and call the Attendance Hotline and inform them

    Show the attendant when asked during the entrance process that you have been exposed OR stay at home and call the Attendance Hotline and inform them

    Attendance Hotline #: 1 (888) 378-8407
  • Please Hit Submit After Calling In OR Talking To The Attendant
  • Show the attendant when asked during the entrance process that you do not understand the awareness portion of this questionnaire OR stay at home and call the Attendance Hotline and inform them

    Show the attendant when asked during the entrance process that you do not understand the awareness portion of this questionnaire OR stay at home and call the Attendance Hotline and inform them

    Attendance Hotline #: 1 (888) 378-8407
  • Please Hit Submit After Calling In OR Talking To The Attendant
  • Should be Empty: