Health Check Before Work For Staff

Are you feeling well today? *




Since your last day of work, or last visit here, have YOU had any of these symptoms? *
  • Fever or chills
  • Cough (not due to allergies)
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose(not due to allergies)
  • Nausea or vomiting
  • Diarrhea



Has someone in your home or someone you have had close contact with (within 6 feet for more than 10 minutes), exhibited any of these symptoms: *
  • Fever or chills
  • Cough (not due to allergies)
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose(not due to allergies)
  • Nausea or vomiting
  • Diarrhea



In the last 30 days, have you, someone in your home, or someone you have had close contact with (within 6 feet for more than 10 minutes) tested positive for COVID-19? *




You answered "YES". Do not enter the facility, proceed to your vehicle, and contact your supervisor and/or HR (Tina Pacific - 949-246-7453) for additional instructions. Please click the 'Submit' button.

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