COVID19-Self Assessment

<img loading="lazy" src="https://www.flextg.com/wp-content/uploads/2020/05/FTG-Covid-19-Self-Assessment-Icon2-300x180.jpg" alt="" class="wp-image-11774 alignleft size-medium" width="300" height="180" />Before coming to the office, please take this COVID-19 Self Assessment

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

Date*
Date Format: MM slash DD slash YYYY
Name*
First Last
FTG Company*
Email*
Have you had contact with or cared for anyone who has a confirmed or possible case of COVID-19 in the last 14 days?
- Yes
- No
* If you answered 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*
- I DO NOT experience any of the above symptoms
- I DO experience 1 or more of the above symptoms
* If you DO experience any of the above symptoms, DO NOT go to work, and please call your Supervisor to inform them.

Download the FTG Safe Work Handbook here:

COVID19 Handbook 8.18.20 is now available.

Changes/additions made in this version (08/18/20)

Added guidelines and recommendations for masks

Past Updates

Changes/additions made on (06/23/20)

Added Service Technicians Call Process/Expectations
Added Customer Expectations for service calls

Changes/additions made on (06/12/20)

Glove Use In The Workplace
Made 2 different sections for (1) general office employees and (2) field service technicians and warehouse/parts employees
Added CDC/OSHA instructions on how to put on/take off gloves