Self-Assessment for KTRs entering DOD workplace.docx

Contractor employee may utilize this daily self-screening assessment prior to entering Department of Defense (DOD) Workplace

Daily Self-Screening Assessment for PHNSY & IMF Contractor Employee Entering Department of Defense (DOD) Workplace

1. Have you or others living in your house travelled from outside of the island of Oahu in the last 14 days?

If Yes, you (contractor employee) are restricted from entering the DOD workplace for 14 days after the traveler arrived to Oahu, and must notify your employer immediately.

If No, continue assessment.

2. Are you currently experiencing symptoms of fever, cough, and/or shortness of breath?

If Yes, you (contractor employee) are restricted from entering the DOD workplace, and must notify your employer immediately.

If No, continue assessment.

3. Have others living in your house identified as having COVID-19?

If Yes, you (contractor employee) are restricted from entering the DOD workplace for 14 days, and must notify your employer. The 14-day period starts from the day the contractor employee learns of the cohabitant’s positive testing for COVID-19.

If No, continue assessment.

4. Have you tested positive or deemed presumptively positive for COVID-19 by a primary health provider or under the authority of a public health official?

If Yes, please contact your employer immediately, and your employer shall notify the Government immediately. Written medical clearance is required to return back to the DOD workplace. A contractor employee’s company is responsible for maintaining the written medical clearances and providing to the Government upon request.

If No, continue assessment.

5. Have you been in close personal contact (as defined below) with any individual(s) testing positive or deemed presumptively positive for COVID-19 within 14 days prior to (a) the individual first exhibiting symptoms of COVID-19 under CDC guidelines and/or (b) the date the individual tested positive or was determined as presumptively positive for COVID-19, whichever occurred first? Close personal contact is defined as (a) within 6 feet for about 10 minutes or (b) had direct contact with secretions (being coughed on, sneezed on, kissing, sharing utensils, etc.).

If Yes, please contact your employer immediately, and your employer shall notify the Government. You (contractor employee) are restricted from entering the DOD workplace for 14 days from the date of last contact with the COVID-19 positive/presumptive positive test of the employee they came into contact with.

If No, assessment complete; continue to enter DOD workplace.