- In compliance with the Safer at Home Universal Guidelines issued by the Governor’s Reopening Taskforce updated on April 1, 2021, CCSNH employees who have been scheduled to work on-site must be screened daily prior to reporting to work. The screening information collected from employees shall be used only for the purpose of maintaining healthy business operations and shall be maintained as confidential. Prior to the beginning of a shift, each on-site employee, student and visitor shall complete this form or the COVID App.
Date Format: MM slash DD slash YYYY
(NOTE: Healthcare workers caring for COVID-19 patients while wearing appropriate personal protective equipment
are not considered to have close contact exposure and should answer “no” to this question.)
(NOTE: Essential travel to/from Canada includes for work, school, personal safety, medical care, care of others, or parental shared custody. Essential travel also includes travel for students and their parents or guardians who are visiting institutions of higher learning or preparatory high schools as future students, including allowing the students to remain at the schools for overnight stays.)
If you answered yes to any of the questions above or have a temperature that exceeds 100.4 degrees Fahrenheit, you will need to remain at home or leave the workplace and report home, and contact your Instructor if you are a student or the Human Resources Office if you are an employee.
I attest that I have answered the above information truthfully. I understand that any falsification of information may be grounds for corrective action, which may include disciplinary action.