Sunnking Covid-19 Daily Checklist

COVID-19 Daily Health Checklist

REVISED QUESTIONS AS OF 11/11/2020, PLEASE READ THEM! DON'T FORGET TO CHECK YOUR TEMPERATURE WHEN YOU ARRIVE AT WORK!
Name *

First Name Last Name
Do you currently have any of the following symptoms?
- Fever (100.4°F or higher), or a sense of having a fever.
- New cough that you cannot attribute to another health condition.
- New shortness of breath that you cannot attribute to another health condition.
- New sore throat that you cannot attribute to another health condition.
- New muscle aches that you cannot attribute to another health condition, or that may have been caused by a specific activity (such as physical exercise).
- New headache that you cannot attribute to another health condition.
- New congestion or runny nose that you cannot attribute to another health condition.
- Nausea or Vomiting
- Diarrhea
- Loss of taste or smell
*

Yes No
Have you, or anyone you live with, been within 6 feet and without a mask with anyone who has tested positive for COVID-19 or who has had symptoms of COVID-19 in the past 14 days? *

Yes No
Have you tested POSITIVE for COVID-19 in the past 14 days OR are you awaiting the results of a recent COVID-19 test? *

Yes No
Have you traveled out of New York State in the last 14 days? *

Yes No
- By entering my initials below, I certify the answers in the above questions. At any time, if I start showing these symptoms, I will inform my supervisor immediately.
INITIAL HERE *
Should be Empty:

COVID-19 Daily Health Checklist