CDRPC COVID19 Screening Form and Office Entry Log.
CDRPC is required to 1) Implement mandatory health screening assessment (e.g. questionnaire, temperature check) before employees begin work each day and for essential visitors and 2).maintain a continuous log of every person, including workers and visitors, who may have close contact with other individuals at the work site or area; excluding deliveries that are performed with appropriate PPE or through contactless means; excluding customers, who may be encouraged to provide contact information to be logged but are not mandated to do so.
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Full Name
*
First Name
Last Name
Do you have any of the following symptoms?:
*
New and persistent cough
Shortness of breath or any difficulty breathing
Fever
No Symptoms
Have you been in contact with anyone in the last 14 days who is experiencing these symptoms?
*
Yes
No
Have you been in contact with anyone who has since tested positive for Covid-19?
*
Yes
No
Not Sure
Within the last 14 days have you returned from a state on NYS's quarantine list? If yes, where did you go?
Submit
Should be Empty: