STOP – *Prior to clocking in/signing into Paychex for an on-site work shift Employees must have answered “No” to all questions on the COVID-19 Employee Questionnaire, per below instructions*

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.

  1. Do you have a temperature which is 100.4 degrees or greater (employee is required to take his/her temperature prior to answering)?
  2. 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?
  3. Have you had direct contact with persons known to be diagnosed with COVID-19 within the past 14 days?
  4. Do you currently have any known symptoms of COVID-19?
  • Fever or chills
  • Cough or wheezing
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Abdominal pain
  • Nausea or vomiting
  • Diarrhea
  • Dehydration
  • 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.

I have reviewed the questionnaire and wish to access this page: