Please enable JavaScript in your browser to complete this form.All BCS Employees are required to complete this COVID-19 Daily Screening Questionnaire prior to starting your shift, including checking your temperature with provided Temp Scanner* *If you have a temperature greater than 99.6 or answers YES to any question, you should: 1. Put on a mask 2. Go straight home. 3. Call employee health or your Doctor.* *Temp 99.6F (37.5c) or lower 95.5F(35.3c) Up to 99.6 is acceptable.*IT IS EXTREMELY IMPORTANT THAT YOU BE TRUTHFUL WITH YOUR ANSWERS. YOU MAY HAVE A SIGNIFICANT IMPACT ON OTHERS. Name: *Date / Time *DateTimeEmployee Badge Number: *Please record your current temp from Temp Scanner: *Feeling Feverish or Measured Temp > or = to 100F? *YES (1. Put on a mask 2. Go straight home. 3. Call employee health or your Doctor.)NOAre you experiencing a NEW COUGH? *YES (1. Put on a mask 2. Go straight home. 3. Call employee health or your Doctor.)NOAre you experiencing SHORTNESS OF BREATH? *YES (1. Put on a mask 2. Go straight home. 3. Call employee health or your Doctor.)NOAre you experiencing CONJESTION or RUNNY NOSE? *YES (1. Put on a mask 2. Go straight home. 3. Call employee health or your Doctor.)NOAre you experiencing a HEADACHE? *YES (1. Put on a mask 2. Go straight home. 3. Call employee health or your Doctor.)NOAre you experincing FATIGUE? *YES (1. Put on a mask 2. Go straight home. 3. Call employee health or your Doctor.)NOAre you experiencing a SORE THROAT? *YES (1. Put on a mask 2. Go straight home. 3. Call employee health or your Doctor.)NOAre you experiencing a LOSS OF TASTE or SMELL? *YES (1. Put on a mask 2. Go straight home. 3. Call employee health or your Doctor.)NOAre you experiencing NAUSEA/VOMITING /DIARRHEA? *YES (1. Put on a mask 2. Go straight home. 3. Call employee health or your Doctor.)NOHave you had ANY CONTACT with confirmed or diagnosis of or suspected cases of COVID 19? *YES (1. Put on a mask 2. Go straight home. 3. Call employee health or your Doctor.)NOI understand I need to go home. YES (1. Put on a mask 2. Go straight home. 3. Call employee health or your Doctor.)NOScreener? *ONLINEFRONT DESK EMPLOYEE*Legal Disclaimer - By checking the box below...I agree to the BCS terms...Signature *Clear SignatureMore legal here...Submit Share this:TwitterFacebookLike this:Like Loading...
