PRE-SCREENING QUESTIONNAIRE

The following questions need to be answered and documented by all employees and visitors prior to allowing access to the workplace and / or jobsite. Documentation will be incorporated to the on-site daily log. The Project Superintendent or designated Checkpoint Administrator has been trained to administer this session. These questions will be asked on a daily basis until further notice, even if the employee / visitor has received a negative COVID-19 test result in the past.

1. Have you, or anyone in your household, come into close contact (within 6 feet) with someone who has had a suspected or confrmed COVID–19 diagnosis in the past 14 days (whether at home, on a jobsite, etc.), while not taking the necessary precautions as outlined by the CDC (e.g., wearing a facemask, washing hands and / or not touching mouth / nose / eyes if coming into contact with potentially contaminated surfaces)?

Yes No

2. Have you had a fever (greater than 100°F / 38.0°C) in the past 72 hours (3 full days)?

Yes No

3. If you answered “No” to Question 2 (above), have you taken any medicines in the past 72 hours (3 full days) that may have reduced a fever?

Yes No

4. Have you had symptoms of lower respiratory illness (such as cough, sore throat, fatigue, shortness of breath, or diffculty breathing) that lasted for more than one day, in the past 7 days?

Yes No

“YES” ANSWERS: If an employee, visitor, or vendor answers ‘Yes’ to any of the questions above, they must leave the workplace or job site immediately and seek a medical evaluation. Additionally, they should strongly consider following the tips provided below. As employees arrive at work, and during their daily evaluation, they should be observed for symptoms (including: coughing, excessive sweating, shortness of breath, diffculty talking or breathing) and must be immediately removed from the job site and sent home with the recommendation that they should see a doctor and / or be tested for COVID-19, if such testing is available.

NOTE:

The above questionnaire is based on CDC guidelines as published on their website as of 04/10/20. This is constantly evolving as new information becomes available, and therefore subject to change. Please consult the CDC website for the most up to date guidelines available. xvi