COVID Symptom Checker Form for Staff

Full Name *

In the last 2 weeks, have you... ?
Been in contact with someone who tested positive for COVID-19?*
YesNo

Tested positive for COVID-19 yourself?*
YesNo

Do you have any of the following?

Fever or chills *
YesNo

Cough *
YesNo

Mild difficulty breathing or shortness of breath *
YesNo

Excessive fatigue *
YesNo

Headache *
YesNo

Sore throat *
YesNo

Muscle or body aches *
YesNo

Nausea or vomiting *
YesNo

Diarrhea *
YesNo

Loss of taste or smell *
YesNo

Congestion or runny nose *
YesNo

Other symptoms? Please describe:

If you are feeling sick, stay home and schedule a free COVID test at a local pharmacy or test site. Paid time off is available.

If you feel that you have very mild, non-specific symptoms that won’t interfere with your work, please contact Dr. Downes and take a COVID self-test at Paoli Vetcare before you begin your shift. Depending on your situation, we may ask you to re-test in 48 hours. We believe it’s better to be safe than sorry!