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?

Do you have a new cough that you cannot attribute to another health condition?

Do you have shortness of breath that you cannot attribute to another health condition?

Have you come into close contact (within 6 feet) with someone who has a laboratory-confirmed COVID-19 diagnosis in the past 14 days?

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

Do you agree to alert production if you test positive for Covid-19 in the next 14 days for contact tracing purposes?

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?

Daily Health Questionnaire

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