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Please take this COVID-19 Self Assessment BEFORE coming into the office

COVID19-Self Assessment

The objective of this self-assessment is to keep our employees safe and protect FTG from liability.

"*" indicates required fields

Date*
Name*
Have you had contact with or cared for anyone who has a confirmed or possible case of COVID-19 in the last 14 days?*
* If you answer "YES" to this question, DO NOT go to work and please call your Supervisor to inform them.

Do you experience or have any of the following?
  1. A temperature of 100.4 degrees Fahrenheit or higher after taking your temperature in the last hour
  2. A cough
  3. Chills or repeated shaking chills
  4. Muscle aches
  5. A sore throat, have a loss of taste or smell
  6. Nausea, vomiting or diarrhea
Self-Assessment/Acknowledgement*
* If you answer "I DO" to this question, DO NOT go to work and please call your Supervisor to inform them.

Current COVID19 Handbook: Updated February 7th, 2022