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  • Employee COVID-19 Self Screening Questionnaire

    Signature required, needs to signed on smart phone or tablet.
  • You must answer “NO” to all the questions in this questionnaire each day in order to work with H.A.T.C.H. clients. If you answer “YES” to any of these questions, please notify the client, the client's family, or the facility in which the client resides in.

     

    If you experience any symptoms or answer “YES” to any of these questions, you must immediately contact your health care professional for recommended next steps AND notify H.A.T.C.H.

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  • If you answered “Yes” to question one, please DO NOT come into work. You should:

    • 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)
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  • If you answered “Yes” to any part of question two, please DO NOT allow the H.A.T.C.H. employee to come into work. You should self-quarantine for at least 14 days.

     

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

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