Attachment 4 COVID-19 Screening Questionnaire_2022-10-31.pdf

NEWPORT

22-NUWC-GRA/0211U_r3

November 2022

Regardless of your vaccination status, have you experienced any of the symptoms in the list below in the past 48 hours?

Are you an o�cial on-site visitor to NUWCDIVNPT?

Are you isolating or quarantining because you tested positive for COVID-19 or are worried that you may be sick with COVID-19?

Have you been in close physical contact in the last 10 days with a person who is known to have laboratory-con�rmed COVID-19 or with anyone who has any symptoms consistent with COVID-19?

IMPORTANT: Answer “YES” even if you believe the symptom(s) is because of some other medical condition (for example, answer “yes” if you have a runny nose because of allergies).

Fully Vaccinated: : If you're fully vaccinated and visiting NUWC Division Newport, you do not need to quarantine upon your arrival as long as you remain symptom free. O�cial visitors must complete the DD Form 3150 Certi�cation of Vaccination form and present it to B80 Visitor Control as an attestation of their vaccination status before entry is authorized.

People are considered fully vaccinated two or more weeks after they have received the second dose of a two-dose vaccine series or two or more weeks after they have received the single dose of the Johnson & Johnson (Janssen) vaccine.

Unvaccinated or Decline to Provide Vaccination Status: O�cial visitors who are not fully vaccinated against COVID-19, or who decline to volunteer their COVID-19 vaccination status, must also show an electronic or paper copy of negative results from a U.S. Food and Drug Administration authorized or approved COVID-19 test administered no earlier than 72 hours prior to their visit (self-administered test kit results acceptable).

These requirements related to the provision of information about vaccination and provision of proof of a recent negative COVID-19 test do not apply to members of the public entering a federal building or federal land to obtain a public service or bene�t. If they are not fully vaccinated, these visitors must comply with all relevant CDC guidance, including wearing a mask and physically distancing from other people.

Close physical contact is de�ned as being within 6 feet of an infected/symptomatic person for a cumulative total of 15 minutes or more over a 24-hour period starting from 48 hours before illness onset (or, for asymptomatic individuals, 48 hours prior to test specimen collection).

Up-to-Date on vaccination3 or Recovered from COVID-19 in past 90 Days:

No quarantine is necessary as long as they remain symptom free. CDC recommends testing 5 days following a known exposure to someone with suspected or con�rmed COVID-19 and wearing a mask in public indoor settings for 10 days from the date of last close contact.

Fully Vaccinated but not Boosted (if eligible) or Unvaccinated Personnel: Complete a 5 day quarantine from date of last close contact. Follow CDC Guidance4 and NUWCDIVNPT Return to Work Guidance2 prior to entering any

NUWCDIVNPT facilities.

If “YES,” LEAVE/DO NOT ENTER the workplace. Military and civilian personnel immediately inform supervisor. Contractor personnel inform employer. Follow CDC Guidance1 and NUWCDIVNPT Return to Work Guidance2 prior to entering any NUWCDIVNPT facilities.

If “YES,” follow guidance below. If you have answered “NO” to this and all other questions, you are clear to access NUWCDIVNPT.”

If “YES,” follow guidance below. If “NO,” proceed to next question.

If “NO,” proceed to next question.

If “YES,” LEAVE/DO NOT ENTER the workplace. Military and civilian personnel immediately inform supervisor. Contractor personnel inform employer. Follow CDC Guidance1 and NUWCDIVNPT Return to Work Guidance2 prior to entering any NUWCDIVNPT facilities.

If “NO,” proceed to next question.

• fever or chills

• cough

• shortness of breath or di�culty breathing

• fatigue

• muscle or body aches

• headache

• new loss of taste or smell

• sore throat

• congestion or runny nose

• nausea or vomiting

• diarrhea

NUWCDIVNPT COVID-19

Screening Questionnaire

1 https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html 2 https://newportalv4.nwpt.nuwc.navy.mil/10/CVG/SitePages/Guidance.aspx 3 Up-to-date COVID-19 vaccination: Term for an individual who has also received all CDC recommended COVID-19 vaccine dose(s), including booster dose(s), when eligible.

Up-to-date COVID-19 Vaccine and booster guidance is subject to change and is available on the CDC website.

4 https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html#quarantine

More information can be found at: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html