Daily COVID-19 Employee Infection Control Questionnaire

  • It is expected that you understand these questions and stay home if any of these answers are “Yes”, DO NOT REPORT TO WORK. Contact your health care provider and Cristy Stedl in Human Resources at 920-418-4056 or cstedl@medalcraft.com.

    If all the above are “No”, please stand in front of the HAVIRON Thermal Unit for your temperature to be taken, if your temperature is 100.4 or higher, you will not be allowed into the building. Please go to your vehicle and wait for 30 min and come back and retest. If still high, please leave and contact your health care provider and Cristy Stedl. If cleared, please then turn this form in to your manager or HR.

  • CERTIFICATION

    I hereby certify that the responses provided above are true and accurate to the best of my knowledge.
  • Please enter your full name
  • Note: The information collected on this form will be used to determine only whether you may be infected with COVID-19. The information on this form will be maintained as confidential. Any questions should be directed to your manager or HR.