COVID-19 Employee Questionnaire

Employee ID Number *

Are you experiencing any of the following symptoms and seeking medical attention? If yes, please contact your manager. (Pre-existing conditions do not need to be reported)

In the two weeks before you felt sick, did you:

Have contact with someone diagnosed with COVID-19?
Live in or visit a place where COVID-19 is spreading?
Neither

In the past 14 days, have you been in close proximity to anyone who has tested positive for or is presumed to have COVID-19? *

Any additional comments you'd like to add? (not required)

COVID-19 Employee Questionnaire

Contact Us

Offices

Headquarters

Satellite Offices

Contact

Email

Departments

Hours

Send a Message

Monday	8:00 AM – 5:00 PM
Tuesday	8:00 AM – 5:00 PM
Wednesday	8:00 AM – 5:00 PM
Thursday	8:00 AM – 5:00 PM
Friday	8:00 AM – 5:00 PM
Saturday	8:00 AM – 5:00 PM
Sunday	8:00 AM – 5:00 PM