COVID-19 Questionaire | Delta Technologies LLC

Updated on 7/24/2020

The safety of our employees, customers, families and visitors remains our number one priority. As the coronavirus (COVID-19) outbreak continues to evolve, we are monitoring the situation closely and will periodically update company guidance based on current recommendations from the Center for Disease Control and the World Health Organization.

To prevent the spread of COVID-19 and reduce the potential risk of exposure to our employees and visitors, we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measures to protect you and everyone in this building.

Thank you.

COVID-19 Employee Daily Health Screening

First Name

Last Name

Phone

If you answer "Yes" to any of the following questions, your access to the facility is denied.

Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days?

Yes

Have you experienced any of the following symptoms in the last 3 days- fever, persistent dry cough or shortness of breath?

Yes

By checking this box, you certify that your answers above are true to your best knowledge, and accept that access to the facility may be denied

Select a date

Note:

In compliance with the State of Michigan`s Executive Order 2020-145, we require that your temperature be checked upon entering the facility.

If your temperature exceeds 100.4, your access to the facility will be denied.

Thanks for submitting!