COVID-19 Symptom Self-Attestation

Millsaps has taken and will continue to take reasonable and necessary precautions to reduce the risk of exposure to COVID-19 in our work environment.

Employees should be personally and collectively responsible for maintaining a safe lifestyle in order to avoid the risk of exposure to themselves and others. Therefore, employees are expected to abide by the current CDC guidelines to stay healthy, both in the workplace and outside the workplace. The guidelines for safe practices during the coronavirus may be found at the CDC’s website: www.cdc.gov.

Employees must certify and affirm that they:

Have not tested positive for COVID-19 during the past 30 days.
Have not been tested for COVID-19 and are awaiting results.
Have not been in close contact with someone who has tested positive for COVID-19, is suspected of having COVID-19, or has symptoms associated with COVID-19 within the last 14 days.
Do not have a fever (100.4 F or higher) or a sense of having a fever.
Have not experienced any of the following symptoms: fever or chills; cough; shortness of breath or difficulty breathing; fatigue; muscle or body aches; headache; new loss of taste or smell during the past 14 days. Please refer to the CDC Coronavirus Disease Symptom page which includes a Self-Checker.
Have not traveled to any location identified as a COVID-19 “hot spot,” or internationally, during the past 14 days.

Employees must conduct symptom monitoring every day before reporting to work. If an employee is unable to certify the above on any day the employee will enter the worksite, they should immediately notify their supervisor or Human Resources and NOT report to the office. In the event an employee reports to work and begins feeling ill or experiencing symptoms of COVID-19, they must notify their supervisor or Human Resources immediately and avoid other employees at work. In such instance, the employee shall be sent home or to a medical provider depending on the circumstances.

I attest that:

I read and understand the above statements.I read and understand the Return to Work Plan and Guidelines, including my personal responsibility to the health and safety of the college, and will abide by the guidelines and recommendations contained in the Plan.

Employee Name*

Email*

example@millsaps.edu

Date*

Date

*

Employee Signature Clear

Millsaps will maintain the symptom screening/attestation as a confidential record that is retained separately from other records including a personnel record. In compliance with non-discrimination laws, employers are allowed to ask employees if they are experiencing symptoms of the pandemic virus during an outbreak.

COVID-19 Symptom Self-Attestation for On-Campus Employees