1. Have you experienced a fever of 100.4 degrees Fahrenheit or greater, a new cough, new loss of taste or smell, or shortness of breath within the past 5 days?


2. In the past 5 days, have you tested positive for COVID-19 using a test that tested saliva or used a nose or throat swab (not a blood test)? (5 days measured from the date you were tested, not the date you received the test result.)


3. To the best of your knowledge, in the past 5 days, have you been in close contact (within 6 feet for at least 10 minutes) with anyone who has COVID-19 during their infectious period? (the infectious period starts 2 days before the person first had symptoms or before their test date).


4. Are you in compliance with Policy No. 66. Vaccine Mandate and Policy No 65. Employee Wellness Measures? (If you received a religious or medical accommodation, then please be sure to submit proof of your weekly PCR test. If you submitted proof that you received one dose of a two dose vaccine, the please be sure you submit proof of your second dose within 45 days after receiving the first dose.)