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Daily COVID-19 Self Health Screening
This pre-work Symptom Survey must be completed prior to reporting to work today. It is critically important that everyone working is healthy and symptom free. Please complete this brief survey.
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Minutes
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AM/PM Option
Name
*
First Name
Last Name
Phone Number
*
Plant Location
*
Santa Catarina
Nuevo Laredo
Ramos Arizpe
Matamoros
Leon
Huehuetoca
San Louis Potosi
Health Questions
Are you currently experiencing any of these symptoms or have you experienced any of these symptoms in the last 14 days? **If you answer yes to any of these questions, please speak with your Manager.
Sore Throat
*
Yes
No
Vomiting/Diarrhea
*
Yes
No
Fever (37.5° C or higher)
*
Yes
No
Cough (not related to allergies)
*
Yes
No
Difficulty Breathing
*
Yes
No
Have you recently traveled outside of your city?
*
Yes
No
Have you been in close contact with someone with a confirmed diagnosis of COVID-19 or is being tested for COVID-19?
*
Yes
No
Have you traveled or been in contact with someone who traveled by airplane internationally or domestically and / or been aboard any cruise ship in the last 14 days?
Yes
No
Signature
Submit
Should be Empty: