Concern for Independent Living, Inc.
COVID-19 EMPLOYEE QUESTIONNAIRE
Employees must answer “No” to all questions on each scheduled work day, prior to beginning an on-site work shift. If the employee answers “Yes” to any question, he/she should not report to work and must contact his/her direct Supervisor and/or the Human Resources Department.
- Do you have a temperature which is 100.4 degrees or greater (employee is required to take his/her temperature prior to answering)?
- Have you traveled to any foreign countries or U.S. states which are on the New York State Department of Health Mandatory Quarantine List within the past 14 days?
- Have you had direct contact with persons known to be diagnosed with COVID-19 within the past 14 days?
- Do you currently have any known symptoms of COVID-19?
- Fever or chills
- Cough or wheezing
- Shortness of breath or difficulty breathing
- Muscle or body aches
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Abdominal pain
- Nausea or vomiting
- Chest pain
- Pain or tenderness in legs
- Swollen toes
Note: This is not a complete list of symptoms; the CDC continues to update guidance in this area, as it becomes available.
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