Cal Poly Federal Credit Union
Employee COVID-19 Self Screening Questionnaire
You must answer “NO” to all the questions in this questionnaire in order to enter our physical location. If you answer “YES” to any of the questions, please DO NOT enter the credit union.
If you experience any symptoms or answer “YES” to any of these questions, you must immediately contact your health care professional for recommended next steps AND notify Barbara or Joy.
1) Have you had any of the following symptoms in the last 24 hours?
* Cough:
* Shortness of breath or difficulty breathing:
Yes
No
OR at least TWO of the following symptoms in the last 24 hours?
* Fever (usually 100.4 or higher)
* Chills
* Repeated shaking with chills
* Muscle pain
* Headache
* Sore throat
* New loss of taste or smell
Yes
No
If you answered “Yes” to question one, please DO NOT come into work. You should:
  • Self- quarantine for at least 10 days from the date on which you first experienced any of the above symptoms; AND
  • Wait until you have had no fever for at least 3 days (without the use of fever-reducing medication) AND
  • Improved respiratory symptoms (no cough, shortness of breath)
2) In the last 14 days have you:
* Been in contact with someone who was diagnosed with COVID-19?
* Been in close contact with someone who had COVID-19 symptoms?
* Traveled internationally or taken a cruise?
Yes
No
If you answered “Yes” to any part of question two, please DO NOT come into work. You should self-quarantine for at least 10 days.
I certify to the best of my knowledge; this information is accurate.
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Thank You