COVID-19 Screening for Staff members Staff Name First Last Email* Do you have any of the following?Fever - a measured temperature of 100.4F or greaterYesNoTemperatureShortness of breath within the most recent 2 weeks?YesNoCoughYesNoChillsYesNoMuscle PainYesNoSore ThroatYesNoHeadacheYesNoRecent loss of taste or smellYesNoAre you ill or caring for someone who is ill? (Employees who are well but who have a sick family member at home with COVID-19 should notify their supervisor.)YesNo
