CLAIMS

CONSULTING

ENTER FULL NAME

WASH YOUR HANDS

COVER YOUR MOUTH WHEN YOU SNEEZE & COUGH

IF YOU ARE SICK STAY HOME - EMAIL CONFIRM ABSENCE

IF YOU TEST POSITIVE FOR COVID-19 CONFIRM VIA EMAIL

IF YOU HAVE A FEVER DO NOT RETURN TO JOB FOR 48 HRS

ENTRY ONLY THROUGH CONTROLLED ACCESS POINT

USE OF RESTROOMS & BREAKROOMS PROHIBITED

ALWAYS KEEP A MINIMUM DISTANCE OF 6 FT FROM OTHERS

ALL DOCK DOORS TO REMAIN CLOSED WHEN NOT IN USE

CURRENT TEMPERATURE

ENTER YOUR SIGNATURE

COMPLETE THIS FORM DAILY WHILE ON SITE

NAME OF JOB SITE