Daily COVID-19 Employee Self Checklist

Complete your COVID-19 Self Checklist each day before starting work. Check your temperature onsite using a thermometer, or take your temperature at home if available. This questionnaire is for confirmation purposes only. These questions must be answered before you leave to report to the worksite. If you answer yes to any of these questions according to the guidelines, DO NOT REPORT TO WORK.


Do you have any for the following symptoms WITH AN UNKNOWN cause (e.g. not due to asthma, COPD, chronic sinusitis, etc.):

If you reply YES to ANY of the questions above, STAY HOME and

- Step 1: Call Your Supervisor

- Step 2: Monitor your symptoms

- Step 3: Contact your healthcare provider. If at any time a doctor confirms the cause of fever or other symptoms is NOT COVID-19 and approves return to work, an employee may return to work.

If you start feeling sick during your shift, follow steps 1-3 above.

 Physical distancing
 Wear a face covering when not at desk
 Practice frequent handwashing
 Cover your cough and sneeze in your sleeve/elbow
 Clean all high-touch surfaces regularly
 Stay home when sick