Self-Assessment for KTRs entering DOD workplace Rev 13.docx

8/2/2021 Daily Self-Screening Assessment for PHNSY & IMF Contractor Employee Entering Department of Defense (DOD) Workplace - Revision 13 (refer to underlined areas for the changes)

1. Have you travelled from outside of the island of O’ahu in the last 10 days?

If YES, you (contractor employee) are restricted from entering the DOD workplace for 10 calendar days after arrival on O’ahu, and must notify your employer immediately UNLESS you meet one of the following:

A. Restriction of Movement (ROM) waiver was obtained from PHNSY & IMF –AND– you must be exempt from the State of Hawaii travel-related quarantine requirements.

B. PHNSY & IMF sponsor verbally determined you are qualified as an “Immunized Traveler” and met the PHNSY & IMF “immunized traveler” policy –AND– you must be exempt from the State of Hawaii travel-related quarantine requirements.

C. You have fully recovered from a confirmed laboratory diagnosis of a COVID-19 infection within three months from the scheduled ROM start date –AND– you must be exempt from the State of Hawaii travel-related quarantine requirements.

If No, continue assessment.

2. Are you currently experiencing any COVID-19 symptoms in the last 24 hours, but not a close contact or known to be exposed to anyone displaying COVID-19 symptoms? For current Centers for Disease Control and Prevention (CDC) list of COVID-19 symptoms, please go to https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html.

Close contact is defined as someone who:

a. Was within 6 feet of a COVID-19 infected 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 COVID-19 infected individuals, 48 hours prior to positive specimen collection) until the time the COVID-19 positive person is isolated regardless of whether the individuals were wearing face coverings, and/or

b. Had direct contact with secretions (being coughed on, sneezed on, kissing, sharing utensils, etc.) from a COVID-19 infected person.

*Individual exposures added together over a 24-hour period (e.g., three 5-minute exposures for a total of 15 minutes).

If YES, you (contractor employee) are restricted from entering the DOD workplace and must notify your employer immediately. To enter the DOD workplace, the contractor employee shall be asymptomatic for at least 24 hours, without the use of fever-reducing or other symptom altering medicines (i.e. cough medicine, etc.).

If No, continue assessment.

3. Are you currently experiencing any COVID-19 symptoms AND tested negative for COVID-19 AND

a. traveled from off-island in the last 10 days AND/OR

b. had close contact with a confirmed COVID-19 case?

Close contact is defined as someone who:

a. Was within 6 feet of a COVID-19 infected 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 COVID-19 infected individuals, 48 hours prior to positive specimen collection) until the time the COVID-19 positive person is isolated regardless of whether the individuals were wearing face coverings, and/or

b. Had direct contact with secretions (being coughed on, sneezed on, kissing, sharing utensils, etc.) from a COVID-19 infected person.

*Individual exposures added together over a 24-hour period (e.g., three 5-minute exposures for a total of 15 minutes).

If YES, you (contractor employee) shall immediately notify your employer. Subsequently, your employer shall inform their PHNSY & IMF sponsor who will notify COVID-19 Tracking Team and provide further instructions. You may enter the DOD workplace IF at least 14 days have passed since COVID-19 symptoms first appeared AND you are:

(a) asymptomatic for at least 24 hours, without the use of fever-reducing or other symptom altering medicines (i.e. cough medicine, etc.) excluding loss of taste/smell; or

(b) confirmed in writing by a healthcare provider that you may return back to work.

A COVID-19 negative test result will not allow you (contractor employee) to enter back to the DOD workplace earlier than the specified 14-day requirement.

If No, continue assessment.

4. Have other members of your household, i.e. living/staying in your house/hotel room, 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. Subsequently, your employer shall inform their PHNSY & IMF sponsor who will notify COVID-19 Tracking Team and provide further instructions. The 14-day period starts from the day the contractor employee learns of the cohabitant’s positive diagnosis of COVID-19. A COVID-19 negative test result will not allow you (contractor employee) to enter back to the DOD workplace earlier than the specified 14-day requirement.

If No, continue assessment.

5. Have you tested positive, been clinically diagnosed, or deemed presumptively positive for COVID-19 by a health provider or under the authority of a public health official?

If YES, please contact your employer immediately, and your employer shall notify one of the following Contracting Officers immediately:

a. Vivian Fukumitsu – 808-368-0881

b. Janet Baker – 808-347-8785

c. Jackie McGlone – 808-368-0147

If you (contractor employee) are experiencing any COVID-19 symptoms or deemed presumptively positive or clinically diagnosed for COVID-19, you may not enter the DOD workplace until at least 14 days have passed since the date of your last positive COVID-19 test/diagnosis, AND at least 24 hours have passed without experiencing or showing COVID-19 symptoms, and without taking any medications (e.g., Tylenol™ for fever, cough medicine, etc.).

If you (contractor employee) tests positive, but never develops any symptoms, the contractor employee may enter the DOD workplace after 14 days have passed since the date of the contractor employee’s last positive COVID-19 test. The contractor employee does NOT have to be tested negative before entering the DOD workplace after 14 days have passed. A COVID-19 negative test result will not allow you (contractor employee) to enter back to the DOD workplace earlier than the 14-day requirement specified above.

If No, continue assessment.

6. Have you been in close personal contact (as defined below) with any individual(s) testing positive, clinically diagnosed, or deemed presumptively positive for COVID-19 within 48 hours prior to (a) the individual first exhibiting symptoms of COVID-19 under CDC guidelines and/or (b) the date the individual tested positive, clinically diagnosed, or was determined as presumptively positive for COVID-19, whichever occurred first?

Close contact is defined as someone who:

a. Was within 6 feet of a COVID-19 infected 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 COVID-19 infected individuals, 48 hours prior to positive specimen collection) until the time the COVID-19 positive person is isolated regardless of whether the individuals were wearing face coverings, and/or

b. Had direct contact with secretions (being coughed on, sneezed on, kissing, sharing utensils, etc.) from a COVID-19 infected person.

*Individual exposures added together over a 24-hour period (e.g., three 5-minute exposures for a total of 15 minutes).

If YES, contact your employer immediately. Subsequently, your employer shall inform their PHNSY & IMF sponsor who will notify COVID-19 Tracking Team and provide further instructions. If you (contractor employee) are asymptomatic, you 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 you (contractor employee) are experiencing COVID-19 symptoms, you may enter the DOD workplace IF at least 14 days have passed since COVID-19 symptoms first appeared AND you are:

(a) asymptomatic for at least 24 hours, without the use of fever-reducing or other symptom altering medicines (i.e. cough medicine, etc.) excluding loss of taste/smell; or

(b) confirmed in writing by a healthcare provider that you may return back to work.

A COVID-19 negative test result will not allow you (contractor employee) to enter back to the DOD workplace earlier than the 14-day requirement specified above.

If No, continue assessment.

7. Are you (contractor employee) a Person Under Investigation (PUI) for COVID-19?

PUI is defined as an individual:

a. who has been directed/ordered by a healthcare professional to get tested for COVID-19, or

b. currently being tested for COVID-19 as directed/ordered by a healthcare professional and/or waiting for his/her test results.

Note: COVID-19 testing directed/ordered by healthcare professional due to pre-surgery is not considered PUI.

If you (contractor employee) are NOT experiencing COVID-19/flu-like symptoms AND have NO KNOWN close contact* with a COVID-19 positive case and are being tested for COVID-19 for other reasons (e.g. employee request, pre-surgery testing, employer’s company-wide/random testing for prevention measure, state surveillance testing, etc.), you (contractor employee) are NOT restricted from entering the DOD workplace while awaiting test results. The contractor employee may continue to report to the DOD workplace as normal.

If YES, please contact your employer immediately. Subsequently, your employer shall inform their PHNSY & IMF sponsor who will notify COVID-19 Tracking Team and provide further instructions.

You (contractor employee) are restricted from entering the DOD workplace as a PUI for COVID-19.

If you (contractor employee) tested negative for COVID-19, but reported experiencing any COVID-19 symptoms, you (contractor employee) shall be asymptomatic for at least 24 hours, without the use of fever-reducing or other symptom altering medicines (i.e. cough medicine, etc.) AND at least 14 days have passed since symptoms first appeared to enter DOD workplace.

If you (contractor employee) tested negative for COVID-19 and had close contact with a COVID-19 positive/presumptive positive person, you (contractor) employee shall not return to the DOD workplace for 14 days from the date of last contact with the COVID-19 positive/clinically diagnosed/presumptive positive person they came into contact with.

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