COVID SCREENING QUESTIONNAIRE.pdf
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- Solicitation number
- W912EF21B0001
About this file
This document contains a COVID-19 screening questionnaire and details of a federal contract opportunity for roof replacement work. The screening questionnaire outlines six health screening questions regarding COVID-19 symptoms for individuals entering a facility. It indicates anyone answering yes to any question will not be allowed to enter unless cleared by medical staff. Exceptions are listed for critical healthcare workers.
The federal contract opportunity is for replacing the roof on the Little Goose Powerhouse and Elevator Penthouse at the Little Goose Lock and Dam in Dayton, Washington. Solicitation number W912EF21B0001 was issued by the Department of the Army Corps of Engineers Walla Walla District for this project. No further details are provided on response dates, award dates, pricing terms, set asides or incumbent contractors.
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Text version
COVID SCREENING QUESTIONNAIRE
COVID-19
ACTIVE SCREENING QUESTIONNAIRE
W912EF21Q0024
This will be updated as the CDC and WA State Health Department's information on COVID-19 continues to change.
Your health and well-being are of the upmost importance and we are taking measures to keep the facility/office a safe environment for employees as well as the individuals under our charge and the public. Therefore, anyone coming into the facility/office will be screened and part of our screening process will include taking their temperature and asking the following questions.
1.) Within the last 14-days, have you experienced a new cough that you cannot attribute to another health condition?
Yes
No
2.) Within the last 14-days, have you experienced new shortness of breath that you cannot attribute to another health condition?
Yes
No
3.) Within the last 14-days, have you experienced a new sore throat that you cannot attribute to another health condition?
Yes
No
4.) Within the last 14-days, have you experienced new muscle aches that you cannot attribute to another health condition or a specific activity such as physical exercise?
Yes
No
5.) Within the last 14-days, have you had a temperature at or above 100.4 or the sense of having a fever?
Yes
No
6.) Within the last 14-days, have you had close contact, without the use of appropriate PPE, with someone who is currently sick with suspected or confirmed COVID-19? *(Note: Close contact is defined as within 6 feet for more than 10 consecutive minutes)
Yes
No
If the individual answers YES to any of the questions they will not be allow into the facility/office unless determined otherwise by a designated DOC medical professional.
*Facilities identified as begin at critical staff levels in health services may have health care workers authorized by the HQ Emergency Operations
Center to enter the facility under the following guidelines:
• As long as they remain asymptomatic
• Self-monitor symptoms as outlined in the guidance; and
• Always wear a surgical mask at entry and while on facility grounds
File details come from the government source that posted it. Updated .