Atwell/SCS/RVI Health Assessment Form

Health Assessment Form

The CDC recommendations differ for individuals vaccinated and unvaccinated. Please familiarize yourself with CDC recommendations.

**UPDATED**. Have you completed the NEW 2022 Return to Office and Field Acknowledgement and Safety Pledge?

Date:

Date

Company Email:

No personal emails - use autocomplete to select your email.

Office or Location being visited:

SCS and RVi have their own selections.

What location?

I currently am not experiencing any symptoms of illness and am familiar with and will adhere to the applicable CDC Guidelines

Have you received a positive COVID 19 test in the last 14 days?

Sign here (If on phone or tablet use your finger to sign)

Completion Time

:HourMinutes