Virus Screening | staffingetc

Staffing Etc. COVID-19 Screening

Please complete the following form before entering the building.

First Name

Last Name

Select a date

Temperature (If greater than 100.3 Fahrenheit please retake. If remains high, please return to your car and contact via @ 301-403-8838 extension 240)

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

Yes

Within the past 14 days, have you been in close physical contact (6 feet or closer for a cumulative total of 15 minutes) with: • Anyone who is known to have laboratory-confirmed COVID-19? OR • Anyone who has any symptoms consistent with COVID-19?

Yes

Are you isolating or quarantining because you may have been exposed to a person with COVID-19 or are worried that you may be sick with COVID-19?

Yes

Are you currently waiting on the results of a COVID-19 test?

Yes