Employee and Visitor Questionnaire

The safety of our employees, supplier partners, customers, families and visitors remain our top priority. Only business critical visitors are permitted at any of our locations at this time.

To prevent the spread of COVID-19 and reduce the potential risk of exposure to our workforce and visitors, we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measures to protect you and everyone in this building.

Refusal to participate in this process may result in an individual being removed from the work location.

Did you have your temperature taken at the start of shift?

Please locate a site supervisor and have your temperature taken before continuing. If you continue to submit this form without having your temperature taken then you should exit the work site and not return until a company representative tells you it is safe to do so.

Is your temperature equal to or greater than 100.4 °F?

Please locate a site supervisor and have your temperature taken before continuing. If you continue to submit this form without having your temperature taken then you should exit the work site and not return until a company representative tells you it is safe to do so.

Have you or anyone in your family travelled outside of the United States in the last 14 days?

Please continue to fill out, and submit this form then, exit the work site and do not return until a Healthcare provider has instructed you that it is safe to do so.

Do you currently have a sick family member at home with COVID-19?

Please continue to fill out, and submit this form then, exit the work site and do not return until a company representative has instructed you that it is safe to do so.

Do you currently have a fever, cough, shortness of breath, fatigue, muscle aches, or new loss of taste or smell?

Please continue to fill out, and submit this form then, exit the work site and do not return until a company representative has instructed you that it is safe to do so.

Do you currently reside in Washington, Oregon, or Idaho?

Please continue to fill out, and submit this form then, exit the work site and do not return until a company representative has instructed you that it is safe to do so.

Your risk is low.

Please submit this form and continue to follow guidelines on COVID-19, including ways to reduce its spread.