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DSC Employee Screener

Do you have shortness of breath, dry cough, runny nose, sneezing, watery eyes, and/or sinus pain/pressure that is unusual and not related to seasonal allergies?

Yes

Have you experienced headaches, fatigue, or weakness?

Yes

Have you lost your sense of taste and/or smell?

Yes

Do you have a sore throat?

Yes

Is your temperature over 100 degrees?

Yes

Have you been diagnosed with COVID-19 within the last 14 days?

Yes

Have you had contact or cared for someone with a respiratory illness or that has been diagnosed with COVID-19 within the last 14 days?

Yes

Name:

Worksite:

Main Building - Admin/Development/Training

Main Building - Business/Front Office/HR

Main Building - Case Management

Main Building - CDS

Main Building - Community Living

Main Building - Family Development

Main Building - Maintenance

Main Building - Residential

Clark - Business Operations

Crow

Employment Services

Philo

Pole Barn

CU Independence

Campbell

Creve Coeur

Devonshire

Foothill

Georgetown

Hartle

Jordan

Kathryn

Kerr

Trowbridge

Date & Time:

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