Atwell/SCS/RVI Health Assessment Form

Health Assessment Form

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

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

YesNo
Date:*

MonthDayYear
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)

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