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Crickler Facilities COVID-19 Screening
Name
*
First
Last
Are you a vendor/supplier (Not Crickler)?
*
If you are not an employee at Crickler, select yes. If you are a Crickler employee, select no.
Yes
No
Company name
Crickler location
*
Rochester
Buffalo
Elmira
Temperature:
*
If your temperature is 99.5 or above, you must return home and wait until a manager reaches out to you with further instructions before returning to work.
Have you experienced any of the following symptoms in the past 48 hours?
*
Check all that apply.
Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Consistent Headache
New loss of taste or smell
Sore Throat
Congestion or runny nose (not due to allergies)
Nausea or vomiting
None
Within the past 14 days, have you been in close physical contact with someone who is COVID positive or showing symptoms?
*
Close physical distance would be 6 feet or closer for a cumulative total of 15 minutes in which one or both people were not wearing masks. -- Check all that apply.
Yes, someone who is known to have laboratory-confirmed COVID-19
Yes, someone who has symptoms consistent with COVID-19
No, have not been in contact with anyone who is covid positive or showing symptoms
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