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This includes taking reasonable steps to protect your workers and others from coronavirus. SoCo COVID-19 Check is a mobile app that helps employees and employers in Sonoma County prevent and mitigate the spread of the novel Coronavirus. This form assesses the COVID-19 Preparedness and Response Plan at your facility. Employers should also regularly review the safe working practices to ensure compliance and the continued safety of the â¦ Screening is not required for emergency services or other â¦ 2066 0 obj <> endobj 1) Have you been in close contact with a confirmed case of COVID-19 in the last 14 days? If you answer âYesâ to a combination of two of any of the following, please notify your supervisor and leave immediately: Fever, cough, shortness of breath, chills, runny nose, head/body Prior to leaving your residence for work, we ask that you self-assess for risk of COVID-19 by completing the attached form. 4) Have you had a new loss of taste or smell? Yes . Employee COVID-19 Self Screening Questionnaire tracks the health condition of your employee and helps to take the precautionary measures to prevent the spreading of coronavirus in the workspace. h�bbd```b``K��d�\"�$�^��8�,�J�hɔ��UA$s8�d��s��Z`�}`V0)V,�D�� ˁ$c��^b�� [�俅�L��.a`��_�� *� Employee Health Screening Form . Main Campus - Miami; 918-542-8441; 200 I Street NE Miami, Oklahoma 74354 . Check out our COVID-19 Procedure Videos For Fall 2020 . COVID-19 Information. h�b```f``�� Ā Bl,(00�D��r��T�g�>��j�%/�=bX�700D�H��=M�v��A^�[QIYEՀ�/��=7/Oo_ns�Z~>! KYk9?i)��а{�ѱ�Q1`B�q| R��2r��ٙY9��RRӀ*��YŁ�H�Y��ܯ��,-�*�T�/1CFZ��~c[KmGk7X�?\A��~�{�&L��o.��͘6u��Y3�ޟ=o��.Y�p��VP��˷�Z�r�u�W�ݼiÖ�� HI��Xڷg��{�߾k��G��#%�'c-}��'O=8}�� >��o}��w�ݺ}��K��@�@��d��h1Utt�c�ɼ��X`�# (�MrJ`G�gG��`D�AE� �ZP��P�}�YF@Z��EB�"�0L�X�\�_/21�p1{2\c�b��t�)�)z-�r�w�Ҕ8��0�t�_��;�*�0�I��A4P�4��O3�``��x8��!��B�8�!��$�� ... and to our fellow employees to ensure that our return to work is safe and does not create opportunities for additional COVID-19 infections. 6) Have you been asked to self-isolate or quarantine by a medical professional. We would expect employers to implement infection control measures to keep the risk of contracting the virus as low as they can for all staff by conducting a COVID-19 workplace risk assessment. Contact information: of person completing form . Screening should be done at the beginning and at the end of the workday. Pima County â First Aid & Near Miss Report Form COVID-19 EXPOSURE REPORT This form is to be completed immediately by the person who is reporting a known or suspected workplace exposure Name EIN Date of Exposure Report of a known or suspected exposure to COVID-19 in the workplace OR while in the performance of â¦ Agricultural Employer Checklist for Creating a COVID-19 Assessment and Control Plan To prevent and slow the spread of COVID-19, agricultural employers can use this checklist to create a COVID-19 assessment and control plan for applying specific preparation, prevention, and management measures. Can employees telework or otherwise work remotely? COVID-19 Assessment Information: Evaluating Persons with Fever and Acute Respiratory Illness (updated 2/28/2020) 1/1 Obtain a detailed travel history on ALL patients being evaluated for fever and acute respiratory illness. Use the assessment criteria below to determine if COVID-19 should be included in the â¦ 1. CDC Facilities COVID-19 Screening Access To CDC Facilities Not Approved - Further Instructions CDC Notice Regarding CDC Facilities COVID-19 Screening CDC staff who fail to provide accurate information on this form may be subject to disciplinary action. Consider encouraging employees to do a self-assessment each day to check if they have any COVID-19 symptoms (fever, cough, or â¦ No . How have administrative controls (such as foot-traffic control) been used to minimize employee exposure to COVID-19? COVID-19 has put the healthcare industry at center stage with the remarkable demand for diagnostic tests, personal protective equipment (PPE), ventilators and other critical medical supplies. COVID-19 Self-Assessmen t Form Disclaimer -Employees should not discuss personal medical history with supervisors. 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