DAILY EMPLOYEE HEALTH SCREENING


At CooperVision, the safety of our employees, customers, partners and communities is our top priority.

To prevent the spread of COVID-19 and reduce the potential risk of exposure to our workforce, we require each employee to complete this simple screening questionnaire every day before entering the facility and beginning work. You must answer these questions honestly and to the best of your ability. If you do not understand any of the questions, please contact Human Resources.

If you answer YES to any of the questions below, DO NOT ENTER. Please call your supervisor and HR (480-507-7603) as soon as possible to inform them of your status and consult your health care provider.  

Gilbert Kirk Reed (516-660-9008)
 Mesa Josh Cummings (602-330-3842)

 

Thank you for your time and your commitment to keeping our facility safe!

Please type in your Full Name:

TO THE BEST OF YOUR KNOWLEDGE, HAVE YOU:

  • Been in close contact within 6 feet (about 2 arms' length) in the past 14 days with anyone who has tested positive for COVID-19 or who has or has symptoms of COVID-19?


  • Tested positive for COVID-19 in the past 14 days?


  • Experienced any of the following symptoms of COVID-19 in the past 14 days (because the symptoms of allergies, asthma and COVID-19 might be similar, check Yes only if it is a NEW symptom)?
    • Fever (100.4+)
    		 Shortness of breath
    Dry Cough
    		 Tiredness


    Any combination of the below?

    Aches and pains
    		 Sore throat
    		 Diarrhea
    Conjunctivitis
    		 Headache
    		 Loss of taste/smell
    A rash on skin
    		 Discoloration of fingers

    Discoloration of toes

    Please specify which ones:(Please leave Blank if you do not have any symptoms)

    My temperature today is:


    Please select your supervisor's name from the dropdown list below:

    v


    I certify that I have answered the questions above truthfully and to the best of my knowledge. Failure to do so is a violation of Company policy and will result in disciplinary action up to, and including, termination.



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