Daily Health Screening Questionnaire
(last updated September 9, 2022)
Employees returning to the office are required to review the questions below prior to their arrival at the office each day and certify completion.
Instructions:
- Employees who answer “Yes” to any of the questions will be excluded from the workplace for a period of time as indicated as follows and must notify their immediate manager of their absence.
- Employees who answer “Yes” to question 1 are allowed to work in the office but should get tested 5-7 days following a known exposure and monitor for symptoms. However, if employees are living in the same household as someone who has a suspected or confirmed COVID-19 diagnosis, the employee is directed to self-quarantine away from work and test on Day 5 after exposure. Employees may return to the office if they receive a negative test result 5 days after last exposure.
- Employees who answer “Yes” to question 2 are directed to self-isolate away from work for a minimum of 5 days and are encouraged to seek medical care. If you test positive for Covid, you may return to the office after isolating for 5 days if you had no symptoms or if your symptoms are improving. You must wear a high-quality mask indoors for an additional 5 days. If your symptoms have not improved or if you still have a fever, you must continue to isolate until your symptoms improve and you are fever-free for 24 hours (without the use of fever-reducing medication).
- Employees who answer “Yes” to question 3 are directed to stay home from the office and test for Covid-19 immediately. Employees may return to work if their test results are negative and when their Covid-like symptoms improve.
Questions:
- In the last 5 days, have you knowingly been in close contact with someone who has tested positive for COVID-19?
- In the last 5 days, have you tested positive for COVID-19?
- Are you currently experiencing symptoms of COVID-19, including but not limited to fever (100.4 F, 38 C or higher), chills, cough, shortness of breath or difficulty breathing, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, or diarrhea?