• COVID-19 ACTIVE SCREENING QUESTIONNAIRE 

    This will be updated as the CDC and North Carolina State Health Department’s information on COVID-19 continues to change. Your health and well-being are of the upmost importance and we are taking measures to keep the facility/office a safe environment for employees as well as the individuals under our charge and the public. Therefore, anyone coming into the facility/office will be screened and part of our screening process will include taking their temperature and asking the following questions.
  • If the individual answers YES to any of the questions they will not be allowed into the facility/office unless determined otherwise by the designated owner/operator. *However, the following guidelines must apply:  As long as they remain asymptomatic; self-monitor symptoms as outlined in the guidance; and wear a surgical mask at entry and at all times while on facility grounds.
  • I attest that this information is truthful and valid. 

     

  • Clear
  • Clear
  •  
  • Should be Empty: