Listed below are various resources to help you and your company navigate your way through COVID-19.
COVID-19 Pre-Return to Office Confirmation (Shared by Lois Nagie, Director of Human Resources, Delta Dental)
As you know, Company Name has taken numerous precautions to protect the health and safety of our associates and visitors to our offices during the COVID-19 pandemic.
In order to maintain your health and safety and that of your associates, and others in the offices, we are instructing you to carefully read the information below and respond accordingly. If you respond “yes” to any of the questions, you cannot report to work until either cleared by your supervisor or your health care professional. We appreciate your cooperation in responding accurately to this simple questionnaire to further our efforts to keep you and everyone in the offices safe. You will be required to complete this questionnaire by 8pm the night prior to reporting each day you are assigned to report to work.
--Have you been diagnosed with COVID-19 by a healthcare professional or tested positive for COVID-19?
--Have you felt or shown any of the following symptoms within the last 14 days:
--Shortness of breath or difficulty breathing
--Chills and/or repeated shaking with chills
--Recent loss of taste or smell
--Have you been in close contact with anyone who has been diagnosed with or tested positive for COVID-19, or who has displayed any of the symptoms mentioned above within the last 14 days? “Close contact” can include residing with someone, caring for a sick person or being in contact with secretions from a sick person (for instance, being coughed on) or being within 6 feet of a person with COVID-19 for more than about 10 minutes.
IF YOU ANSWERED “YES” TO ANY OF THE ABOVE QUESTIONS, YOU CANNOT REPORT TO WORK. PLEASE NOTIFY YOUR SUPERVISOR IMMEDIATELY AND DO NOT REPORT TO THE OFFICES UNTIL YOU ARE CLEARED TO DO SO.
I hereby confirm and state to the best of my knowledge that I do not have any of the symptoms set forth above and have not been in close contact with any individuals as set forth above.
Signature of Associate/Tenant Date
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