Daily Self Certification by Employee

NEW YORK OFFICE

641 Lexington Avenue – 24th Floor
New York, New York, 10022, USA
1.212.593.9700
[email protected]

Daily Self Certification by Employee

In an effort to reduce the risk of COVID-19 exposure to TWCC employees, subcontractors, and visitors, everyone must undergo temperature and health checks. This can be performed at home with a touchless or oral thermometer prior to entering the facility and completing this form to certify that you have self-administered a daily temperature and health check.

Date*
Date Format: MM slash DD slash YYYY
Time*
Select Job Address*
Employee Name*
First Last
Subcontractor's Name*
Supervisor's Name*
Daily Self-Certification by Employee – Prior to Entering Jobsite*
- I hereby certify that I have self-administered a temperature check screening today before entering this building or upon entering.
- I hereby certify that I do not have a temperature at or above 100.4 degrees.
- I hereby certify that I have not had any known exposure to the COVID-19 virus.
- I hereby certify that I am not currently having or have had within the last 14 days any flu-like symptoms (fever, cough, shortness of breath or other respiratory problem).
Consent
By submitting this form, I hereby certify that to the best of my knowledge, the answers I have given are truthful and accurate. I understand that the information I submit on this form or online will be kept confidential.
Signature*
Please type in your full name.
Company Name*
Company Phone #*
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Daily Self Certification

MISC

NEW YORK OFFICE

Daily Self Certification by Employee