• GHA Autism Supports Daily COVID-19 Self Declaration Form

    For the health and safety of our community & those we serve, declaration of illness is required. Be sure that the information you'll give is accurate and complete. Please get immediate medical attention if you have any of the COVID-19 signs. Complete this form at the beginning of your shift, IMMEDIATELY after clocking in.
  • *Failure to answer questions accurately/honestly will result in disciplinary action- (including possible termination)

  • If you currently have or have had any of the above listed symptoms in the past 10 Days, do NOT begin your work shift- Contact your Manager immediately!

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  • Check your current temperature. IF 99.5 OR HIGHER, CONTACT YOUR MANAGER IMMEDIATELY and DO NOT BEGIN YOUR WORK SHIFT!

  • By signing below, I acknowledge that the information I've given is accurate and complete.

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