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Toscana Chophouse Employee COVID Sign-In Form
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Tuscan Kitchen Burlington Employee Feedback Survey
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Employee COVID Sign-In Form
Name
*
Date
*
Time
*
Have you been in close contact with a conformed case of COVID-19 / ¿Ha estado en contacto con un caso confirmado de Covid 19?
Yes
No
Are you experiencing a cough, shortness of breath or sore throat? / ¿Has experimentado tos, dificultad para respirar o dolor de garganta?
Yes
No
Have you had a fever in the last 48 hours? / ¿Has tenido fiebre en las últimas 48 horas?
Yes
No
Have you had changes in your sense of taste or smell? / ¿Has tenido perdidad en del gusto o del olfato?
Yes
No
What was your temperature on the provided thermometer when you arrived? / ¿Cuál era tu temperatura en el termómetro proporcionado cuando llegaste?
*
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