If you identified any symptoms above which have caused you to leave the worksite, then please provide your email at the bottom of this form and a Fire Department Nurse will contact you (within 24 hours) with further direction. After leaving the worksite, you may work remotely, or use accrued leave balances. In the event you are experiencing severe symptoms, you should contact your personal physician.
The content of this document shall not form the basis of employee evaluations or any disciplinary measures. This document serves only as an aid to the employee in completing the self-check process required prior to physically reporting to work; and to allow the City to verify employee completion of the self-check process. The document shall not be provided to any party(s) outside of the City of Anaheim except as required by law.