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IT Staff Sign-in Longform

  1. Please enter the time at which you arrived to the office.

  2. Please enter the time at which you left the office.

  3. Please answer the following questions

  4. Do you have a cough?*

  5. Do you have a fever? (Each member will have their temperature checked manually. 100.4 indicates potential infection)*

  6. Do you have any breathing problems?*

  7. Have you had an exposure to anyone who has been exposed to or infected with Covid-19?*

  8. If you answered yes to any of the above questions you should NOT report to work. You should isolate at home and contact your primary care physician.

  9. Leave This Blank:

  10. This field is not part of the form submission.