Have you:

(a) knowingly been in prolonged close or proximate contact in the past 14 days with anyone who has tested positive for COVID-19 or who has or had symptoms of COVID-19;

(b) tested positive for COVID-19 in the past 14 days; and/or

(c) experienced any symptoms of COVID-19 in the past 14 days (cough, shortness of breath or difficulty breathing, fever, chills, muscle pain, sore throat, or new loss of taste or smell)?

If you answered “no” to all of the questions above, press the SUBMIT button below.


you answered “no” to (a) and (b) but answered “yes” to (c), if you:

(i) are no longer experiencing any of those symptoms AND

(ii) took a COVID-19 test after the symptoms resolved and received a negative test result,

press the SUBMIT button below.

OTHERWISE, do not submit this form – you will have to continue to work from home. Please remember that you must complete this questionnaire every day you intend to come to the office.

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