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Prior to the start of a work shift, all employees will complete a COVID-19 Employee Health Self Certification. The city will maintain all health information as a confidential medical record in compliance with state and federal law, including but not limited to, the Americans with Disabilities Act, the Fair Employment and Housing Act, and the Confidentiality of Medical Information Act.
If YES to any, do not enter the workplace. Return home and contact your healthcare provider.
Close contact means within 6-feet or coming in direct contact with secretions (e.g., sharing utensils, being coughed or sneezed on, etc.). The timeframe for having contact with an individual includes the period of time of 48 hours before the individual became symptomatic.
If NO, proceed to remaining question.
If YES, do not enter the workplace. Return home and follow the advice of your medical provider.
I understand that my employer is relying upon the truthfulness of my certification in permitting me to enter the workplace and that there may be adverse consequences for knowingly false responses. I further understand that if I develop any of the above symptoms, I must separate myself immediately from other employees and notify my supervisor and Human Resources immediately.
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