Covid-19 Health Screening Declaration All Visitors and Contractors must complete The the last 14 days, have you had the following? Sudden onset of respiratory illness (congestion, nasal drainage, difficulty breathing) Fever (Temperature greater than 100.4F) Cough, sore throat, loss of smell None of the above Have you had contact with someone that has a confirmed case of COVID-19? Yes No Have you traveled outside of your home country as identified by the CDC/WHO (where COVID-19 exists) during the past 14 calendar days? Yes No Full Name(Required) Company Name(Required) Project Name(Required) Date(Required) MM slash DD slash YYYY Time Hours : Minutes AM PM AM/PM Day of the WeekMondayTuesdayWednesdayThursdayFridaySaturdayBy clicking this box, I confirm that the above information given is correct. I also understand that I must report any changes in my health status to supervision upon or before arrival.(Required) Click to Confirm NameThis field is for validation purposes and should be left unchanged. Follow
