KEC Staff COVID Questionnaire

Today's Date

MonthDay Year
Hour Minutes AM/PM Option
KEC Staff COVID Questionnaire
Name*
Name*
Have you met anyone outside of your household without wearing a mask, eating or drinking, no matter the distance, indoors or outdoors since yesterday?*

NoYes
Have you or a member of your household been in close contact with anyone that tested POSITIVE for COVID?*

NoYes
Please DO NOT come in to work. Call Margarita at (808) 726-1309. Let her know when the possible exposure occured and she will advise you on further instructions.
Have you been wearing a mask outside of work?*

NoYes
Do you feel sick?*

NoYes

Have you had any of these symptoms since yesterday?*