COVID-19 Employee Health-Screening Assessment Form

    If the employee answered yes to any of the questions above, the employee must be sent home.

    If you are sick or have one or more of the above symptoms:
    • You must stay home or leave the JHS facility at which you are working.
    • Follow the agency procedure for calling out sick
    • Contact your health care provider for medical guidance.

    Close contact includes being within approximately 6 feet of a person with confirmed COVID-19 for more than a few minutes, living with a person who has COVID-19 or having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on, kissing, sharing utensils).

    The employee may return to work earlier if a doctor confirms the cause of the employee’s fever or other symptoms is not COVID-19 and provides a written release for the employee to return to work.