There has been new guidance from the CDC on possible symptoms. Please review the questions carefully and answer appropriately.

To comply with safety standards to protect you, the client, and involved others, we require that employees, clients, and those who reside with the client are Covid-19 symptom-free. Please complete and submit this form on days that clients and employees work together in person.

You must answer “NO” to all the questions in this questionnaire for an employee to work with the H.A.T.C.H. client.

If you answered “Yes” to any of the questions, please DO NOT report to work. You should:

• Contact the client, family, facility, or supportive living staff to let them know that you will be unable to work.
• Contact your doctor and follow their health orders. If they have determined that you or someone in your household is Covid-19 positive, you should do the following:
• Self-quarantine for at least 10 days from the date on which you first experienced any of the above symptoms; AND
• Wait until you have had no fever for at least 3 days (without the use of fever-reducing medication) AND
• Improved respiratory symptoms (no cough, shortness of breath)

If you answered “Yes” to any part of question two, please DO NOT report to work if you are doing in-person services. You should self-quarantine for at least 10 days.

Please contact the H.A.T.C.H. office if you need additional personal protective equipment.

I declare to the best of my knowledge; this information is accurate.