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All employees must complete a Health Self-Certification Form questionnaire each day either online or using a paper form. Please answer the following questions prior to coming to work:
First Name
Last Name
If you desire a copy of this signed document, replace the below with your own email address
Site ---ABCEABCIABCLABCPCHEIHTILMPIIMPILSPIBSPIJSPILSPIR
1) Have you experienced any of the following common symptoms in the past 24 hours? *Fever (above 100 degrees F in US or 37.5 degrees C in Mexico) or chills*Cough (not typical or caused by existing condition)*Shortness of breath/difficulty breathing (not typical or caused by existing condition)*Fatigue (not typical, related to physical activity or caused by existing condition)**Muscle or body aches (not typical, related to physical activity or caused by existing condition)*Headache (not typical or caused by existing condition)*New loss of taste or smell*Sore throat*Congestion or runny nose*Nausea or vomiting*DiarrheaYesNo
2) Have you tested positive for COVID-19 and not yet been cleared by a medical professional to return to work?YesNo 3) Have you knowingly been in close contact (i.e. within 6 feet for more than 10 minutes) with someone diagnosed with COVID-19 in the past 14 days?YesNo
If you answered "Yes" to any of the questions above, do not show up for work. You do not need to submit a Health Self-Certification Form if you are not reporting to work. You DO need to report your absence to the call-in attendance line. If you answered "No" to all the questions above, please push 'Submit' below and then PROVIDE YOUR SIGNATURE on the page that opens up.