COVID-19 Screening

This daily screening is required on all R.C. Hendrick & Son jobsites. Please note that if an employee answered "yes" to any of the daily health screening questions below, the employee is not permitted on the work site and should follow CDC and local health department guidelines before returning to work.

If you are working on a site that has Owner-Mandated vaccine requirements, additional question(s) about your vaccination status will appear. If you answer "no" or "prefer not to answer" to that question you will not be allowed on site.
Name: Name: * First Last
Company Name: *
Date Date * / MM / DD YYYY
Jobsite Name: *
Have you been in close contact with anyone diagnosed with COVID-19 in the last 14 days? *

Have you been in close contact with anyone diagnosed with COVID-19 in the last 14 days? Yes No
Have you experienced any symptoms of fever, cough, shortness of breath, sore throat, or diarrhea? *

Have you experienced any symptoms of fever, cough, shortness of breath, sore throat, or diarrhea? Yes No
Are you fully vaccinated for the Flu? *

Are you fully vaccinated for the Flu? Yes No Prefer Not To Answer
Are you fully vaccinated for COVID-19? *

Are you fully vaccinated for COVID-19? Yes No Prefer Not To Answer
I certify that the above information is accurate to the best of my knowledge and I agree to follow the Covid-19 protocols/rules of the place where I am working *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
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