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Menu
Home
About CHQR
Features
The Evolution
Encryption
Contact us
My account
Interisland Form
Register/Login
Costco
Costco Greeter
User Costco CHQR-ID
Happe
Shop
Store Manager
Vendor Registration
Happe State Database
Cart
Checkout
My account
Register
Vendor Membership
Vendor Registration
Daily Health Questionnaire
Phone Number:
Department:
Do you agree to have your temperature checked, wear a CDC approved face covering on and around set that simultaneously covers your nose and mouth, wash and/or sanitize your hands frequently and stay 6ft apart from others during production?
------ select an option ------
Yes
No
Do you have a new cough that you cannot attribute to another health condition?
------ select an option ------
Yes
No
Do you have shortness of breath that you cannot attribute to another health condition?
------ select an option ------
Yes
No
Have you come into close contact (within 6 feet) with someone who has a laboratory-confirmed COVID-19 diagnosis in the past 14 days?
------ select an option ------
Yes
No
Have you experienced any of the following symptoms in the past 48 hours: • fever or chills • cough • shortness of breath or difficulty breathing • fatigue • muscle or body aches • headache • new loss of taste or smell • sore throat • congestion or runny nose • nausea or vomiting • diarrhea
------ select an option ------
Yes
No
Do you agree to alert production if you test positive for Covid-19 in the next 14 days for contact tracing purposes?
------ select an option ------
Yes
No
Are you currently under quarantine orders because you have tested positive for Covid-19 or have been exposed to someone that has tested positive for Covid-19?
------ select an option ------
Yes
No
Submit