Employee Screening Questionnaire
Thank you for all you are doing to support NorthShore, our patients and one another.
View High Risk States
* must provide value
- Had any new symptoms of COVID-19 (Fever, chills, cough, shortness of breath, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion, runny nose, nausea, vomiting, diarrhea),
Traveled to a high risk state*/internationally in the last 14 days, unless your primary residence is in that state.
*Alabama, Alaska, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, Guam, Puerto Rico, and the Virgin Islands.
Had an exposure to a CONFIRMED positive Covid-19 person within the last 14 days?
- Exposure = Within 6 feet for longer than 15 mins AND not wearing appropriate PPE.
- Appropriate PPE = MASK in community/home/coworker OR MASK and EYE PROTECTION for patient care.