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.