Employee Health Screening

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same-day health screening for employees

Updated 1/3/2022 in accordance with the most recent CDC guidelines.

Please complete this screening each day (prior to arriving at the MUSEO studio).

* Indicates required field

Employee Name *

First

Last

Select One *

LEVEL 1 SYMPTOMS
- Muscle or body aches
- Headache
- Congestion or runny nose
- Cough

1. Have you had any of these LEVEL 1 symptoms within the last 48 hours? *

Yes No

If yes, please list ALL the LEVEL 1 symptoms you have that are CONFIRMED TO BE CAUSED BY A CONDITION OTHER THAN COVID-19 (e.g. cough due to seasonal allergies) *

Your judgment impacts the health of others. Please consider this carefully.

A MUSEO administrator will review this information and contact you if we have reasonable concerns of potential risk to others if you were to be in the studio today.

LEVEL 2 SYMPTOMS
- Fever (body temp of 100.0 or higher)
- Chills
- Shortness of breath or difficulty breathing
- Fatigue
- Recent loss of taste or smell
- Sore throat
- Nausea or vomiting
- Diarrhea
- Stomach ache or pain in the abdomen

2. Have you had any of these LEVEL 2 symptoms within the last 48 hours? *

Yes No

Per the CDC and Washington State Department of Health, the presence of any of these LEVEL 1 and LEVEL 2 symptoms WHICH IS NOT CAUSED BY ANOTHER KNOWN CONDITION will exclude you from being in the studio today. Please get a test and stay home.

3. Have you been in close contact with anyone who has COVID-19 in the past 5 days? Close contact is being within 6 feet for 15 minutes or more over a 24-hour period with a person; or having direct contact with fluids from a person with COVID-19 with or without wearing a mask (i.e., being coughed or sneezed on). *

Yes No Possibly

If you answer "yes" or "possibly" and you:
Have been boosted
OR
Completed the primary series of Pfizer or Moderna vaccine within the last 6 months
OR
Completed the primary series of J&J vaccine within the last 2 months

DO THIS:

Wear a mask around others for 10 days.
Test on day 5, if possible.

If you develop symptoms get a test and stay home.

If you answer "yes" or "possibly" and you:
Completed the primary series of Pfizer or Moderna vaccine over 6 months ago and are not boosted
OR
Completed the primary series of J&J over 2 months ago and are not boosted

DO THIS:

Stay home for 5 days. After that continue to wear a mask around others for 5 additional days.
If you can’t quarantine you must wear a mask for 10 days.
Test on day 5 if possible.

If you develop symptoms get a test and stay home

4. Within the past 5 days, has a public health or medical professional directed you to be monitored, isolated, or quarantined because of concerns about COVID-19 infection? *

Yes No

If you answer "yes":

Stay home for 5 days.
If you have no symptoms or your symptoms are resolving after 5 days, you can leave your house.
Continue to wear a mask around others for 5 additional days.

If you have a fever, continue to stay home until your fever resolves.

5. Have you had a positive COVID-19 test for active virus in the past 5 days or are you awaiting results of a COVID-19 test? *

Yes No

If you answer "yes":

Stay home for 5 days.
If you have no symptoms or your symptoms are resolving after 5 days, you can leave your house.
Continue to wear a mask around others for 5 additional days.

If you have a fever, continue to stay home until your fever resolves.

Additional Comments *

By typing my full name into the box below, I certify that my responses are true and accurate. I acknowledge that I play a vital role in the health and well-being of the entire MUSEO Art Academy community. *

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