Health Alert Survey
Measure your temperature twice a day.
If you start feeling symptoms while working, notify your coordinator immediately.
If you continue to work while having symptoms, you may cause the spread of COVID-19
Caregiver Name
*
Caregiver ID
*
Do you have symptoms including fever, cough, shortness of breath, chills, or sore throat?
*
None
Yes
No
or muscle pain, new loss of taste or smell, or gastrointestinal symptoms like nausea, vomiting or diarrhea?
*
None
Yes
No
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Company
*
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Subject
*
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.
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