Pre-Screening Process

Procedure Guidance

On day reporting to work, complete the on-line pre-screen survey for COVID-19.
Based on the responses, practitioners will receive an email if they are approved or denied permission to access restricted facilities. The email will include the date and time. Green will indicate approval; Red will indicate denial.
Approved practitioners will need to display the email upon entry to restricted facilities, either on their mobile device or by printed copy of the email.
Denied practitioners should report this response to their supervisor for required follow-up.

Instructions for Taking A Self-Screening Questionnaire:
Read each question carefully before clicking the “Submit” button.

Date *

Date

Time

Full Name *

Email *

Employer *

*1. Are you currently suffering or showing signs of any of the following: fever or chills, cough, difficult breathing, fatigue, body aches, headache, loss of smell or taste, sore throat, nausea, vomiting, diarrhea? *

*2. In the past 14 days, have you had a positive result from a COVID-19 test, that tested saliva or used a nose or throat swab? (Not a blood test). *

*3. In the past 14 days, have you been in unprotected close contact (within 6 feet for at least 15 minutes) with anyone who has had a positive COVID-19 test, had a moderate to high-risk contact per CDC criteria, or been told by a healthcare provider to self-isolate due to an asymptomatic COVID-19 diagnosis? *

*4. In the past 14 days, have you or anyone in your household traveled outside the country or to any states on the national or state advisory lists? (https://www.cdc.gov/coronavirus/2019-ncov/ travelers/travel-during-covid19.html#check-travel-restrictions) *

Disclosure: * By submitting this questionnaire, I affirm that the information provided by me on this questionnaire is true and correct to the best of my knowledge and belief.

Health Screening

Pre-Screening Process

Procedure Guidance