If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required First Name * Last Name * Date * Job Number Project Location Company Name * Kirk Bros. Co. Inc.Kirk MasonryVisitorSubcontractor Description of Symptoms (Within Last Seven Days) In an effort to reduce the risk of coronavirus (COVID-19) exposure to employees, clients, visitors and community, all employees/subcontractors/visitors/etc. must complete the following Health Checklist BEFORE being allowed on our jobsite(s). Have you been around soemeone who has been showing the symptoms of COVID-19 and/or tested POSITIVE for COVID-19 within the past 14 days? * YesNo Have you had a fever of 100.4 or more at any time in the last 48 hours? * YesNo Are you feeling well today? * YesNo If not, call HR immediately. DO NOT GO TO THE WORKSITE. Please check if you have the following symptoms. * If you have three (3) or more of the symptoms, please leave IMMEDIATELY and contact HR. CoughShortness of BreathSore ThroatLoss of taste/smellMuscle AchesTrouble BreathingChillsNo Symptoms Comments/Concerns NOTE: Please continue to look for the weekly State of Ohio County Map that will be sent out with the toolbox talk. This map is color coded for the level of risk per county for COVID-19. This map can also be viewed at https://coronavirus.ohio.gov/wps/portal/covid-19/public-health-advisory-system/ First Name * Last Name *
