• 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.
  • If you have any of the COVID-19 symptoms below, STOP! Immediately call your manager!

  • *Failure to answer questions accurately/honestly will result in disciplinary action- (including possible termination)

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

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