Member Name:* Temperature* Time Temperature Taken:* : Hours Minutes AM PM AM/PM Please indicate if you have any of the following: Cough Fever of 100.4 or higher Chills Runny Nose Shortness of Breath Sore Throat None of the above Exposure to someone with, or under the investigation for, COVID-19?* Yes No Have you been cleared to provide care/enter facilities? Yes No Company Officer Name:* Share this story email icon. Click to share on email twitter icon. Click to share on twitter facebook icon. Click to share on facebook linkedIn Icon. Click to share on LinkedIn
