DAILY
HEALTH SCREENING










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Enter your name:

Are you currently experiencing any of the following medical symptoms?

  • Temperature over 100 degrees
  • Chills
  • Cough
  • Shortness of breath
  • Difficulty breathing
  • Fatigue
  • Muscle/Body Aches
  • Headache
  • New loss of taste or smell
  • Congestion or runny nose
  • Sore throat
  • Nausea or Vomiting
  • Diarrhea

Have you had contact with anyone who has known or possible exposure to the coronavirus (COVID-19) or other communicable condition in the last 10 days?

Have you received a positive COVID-19 test in the last 5 days or have pending results from a recent COVID test?

In the previous 14 days, have you traveled to or from one of the states listed as high risk by the Pa Department of Health?

LINK TO MOST CURRENT HIGH RISK STATES

Please follow these instructions!

If You Received a Positive COVID-19 Test:

  • Continue isolation for 5 full days past test results and if no symptoms persist, end isolation
  • If symptoms persist past 5 full days, continue isolation until fever-free for a full 24 hour period

    • Please follow these instructions!

    If You Are Experiencing Symptoms:

  • Isolate (regardless of vaccination) and test immediately
  • Positive Test – continue isolation for 5 full days past test date and if no symptoms persist, end isolation
  • Negative Test – end isolation after 5 days from onset of symptoms (non Covid)

    • Please follow these instructions!

    If You Were Exposed to Someone with COVID-19:

  • Wear N95 Mask for minimum of 10 days
  • If you experience symptoms (COVID), isolate immediately and test
  • Positive Test – continue isolation for 5 full days past test date and if no symptoms persist, end isolation
  • Negative Test – end isolation after 5 days from onset of symptoms (non Covid)

    • By submitting this health screen to Human Resources, I attest that the information contained with-in is a true and accurate representation of my health symptoms/condition at the time of this submission. I agree to use PPE and follow universal precautions as indicated for COVID-19.

    Thank you, !

    Please have a great day!