By signing this form, I certify that my answers are true. At any time I start showing any of the symptoms listed above while in the building, I will notify my supervisor via email immediately and leave the building.
Please show the next part of the form to the receptionist by the front door so that she can record your temperature and complete the form.
PLEASE DO NOT ENTER THE BUILDING
Submit this form so that your supervisor knows why you are not in attendance and return home. Once home contact Human Resources for futher instructions.