test3


Employee Company



1. Have you experienced any of the following common symptoms in the past 24 hours?


2. Have you tested positive for COVID-19 or been asked by a medical professional to be tested for COVID-19 in the past 14 days?


3. Have you knowingly been in close contact with someone who has been infected with COVID-19 or asked by a medical professional to be tested for COVID-19 in the past 14 days?



You will be asked to provide your signature once you hit the 'send' button below - please complete the signature process on the next page.