COVID CHECK-IN Name * First Name Last Name Job Number or Address: * Date * MM DD YYYY Company * Are you experiencing any Covid-19 symptoms? * Yes No Have you been in physical contact in the last 14 days who has tested positive or has Covid-19 symptoms? Yes No Have you tested positive for Covid-19 in the past 10 days? Yes No Are you currently waiting for test results for Covid-19? * Yes No If you answered yes to any of the questions above, please contact your supervisor and do not enter job site. Thank you!
