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 clients, employees, and involved others, we require that employees, clients, and those who reside with the client are symptom-free. Please complete and submit this form on days that clients and employees work together.

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 answer “YES” to any of the questions, please DO NOT allow the H.A.T.C.H. employee to enter the client's home or to have them work with the client.

If anyone who resides with the client experiences any symptoms or answer “YES” to any of these questions, you must immediately contact your health care professional for recommended next steps AND H.A.T.C.H.

If you answered “Yes” to question one, please DO NOT allow the H.A.T.C.H. employee to come into work. You should:

• Contact the H.A.T.C.H. employee and notify them that the client or someone in the household is sick. 
• Contact your doctor and follow their health orders. If they determine that someone in the household is Covid-19 positive, please 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 allow the H.A.T.C.H. employee to report to work if you are doing in-person services. You should self-quarantine for at least 10 days.

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