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Employee Screening Checklist

In the last 14 days, I have only worked for MannaCare
TrueFalse

In the last 14 days, I have not arrive in Australia
TrueFalse

In the last 14 days, I have not visited a Tier 1 exposure site
TrueFalse

In the last 14 days, I have not visited a Tier 2 exposure site
TrueFalse

In the last 14 days, I have not visited a Tier 3 exposure site
TrueFalse

I am not current required to self-isolate or quarantine
TrueFalse

I will wear appropriate PPE when required
TrueFalse

I will perform hand hygiene at appropriate times
TrueFalse

I am feeling well
TrueFalse

I do not have a sore throat
TrueFalse

I do not have a runny nose
TrueFalse

I do not have a cough
TrueFalse

I do not have shortness of breath
TrueFalse

I do not have a headache
TrueFalse

I do not have a fever
TrueFalse

I do not have muscle soreness
TrueFalse

I have not had gastro symptoms in the last 48 hours
TrueFalse

I do not have loss or change in sense of taste
TrueFalse

I do not have loss or change in sense of smell
TrueFalse

By submitting this form, I confirm that all questions have been answered truthfully and acknowledge that penalties apply for providing false information.