( ) -
Your manager will be notified via email. Please make sure you use the correct email address.
COVID-19 symptoms defined by CDC: Fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea.
Are you fully vaccinated?:

Did you receive a 3rd shot or booster?:

Do you have direct patient contact?:

Are you pregnant?:

Have you tested positive in the past 90 days?: