Self-Assessment for KTRs entering DOD workplace Rev 3.docx

Contractor employee may utilize this daily self-screening assessment prior to entering Department of Defense (DOD) Workplace 2 July 2020

Daily Self-Screening Assessment for PHNSY & IMF Contractor Employee Entering Department of Defense (DOD) Workplace - Revision 3 (refer to underlined areas for the changes)

1. Have you 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 (≥ 100°), cough, chills, sore throat, shortness of breath/difficulty breathing, new loss of taste or smell, unexplained muscle pain/aches, and/or unusual headache?

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 72 hours (3 days), 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.

If your (contractor employee’s) healthcare provider reports that the symptoms are due to NON-COVID-19 illness then the contractor employee shall follow the healthcare provider’s instruction to return to work as opposed to the written above requirement (14 days passed) to enter the DOD workplace. A written medical note confirming symptoms are not due to COVID-19 shall be maintained by the contractor employee’s company, and provided to the Government upon request.

If No, continue assessment.

3. Have others 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. 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 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 symptoms of fever (≥ 100°), cough, chills, sore throat, shortness of breath/difficulty breathing, new loss of taste or smell, unexplained muscle pain/aches, and/or unusual headache and tests positive or deemed presumptively positive for COVID-19, you may not enter the DOD workplace until at least 21 days have passed since the date your last positive COVID-19 test, AND at least 72 hours (3 days) have passed without experiencing or showing symptoms of fever (≥ 100°), cough, chills, sore throat, shortness of breath/difficulty breathing, new loss of taste or smell, unexplained muscle pain/aches, and/or unusual headache 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 21 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 21 days have passed; however, if the contractor employee has been tested (by nasal swab method) negative twice in a row, at least 24 hours apart, the contractor employee may enter the DOD workplace after 14 days from the first positive test. However, the contractor employee does not need to be retested with a negative result, but must have never developed symptoms.

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. 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.

6. Are you 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 and/or waiting for his/her test results.

If YES, please contact your employer immediately. You (contractor employee) are restricted from entering the DOD workplace as a PUI for COVID-19.

When the COVID-19 test result is negative, you (contractor employee) shall review the criteria restricting entrance to the DOD workplace prior to returning, specifically at betaSAM.gov under notice number N32253-20-NOTIFICATION-COVID19.

If you (contractor employee) tested negative for COVID-19, but reported experiencing symptoms of fever (≥ 100°), cough, chills, sore throat, shortness of breath/difficulty breathing, new loss of taste or smell, unexplained muscle pain/aches, and/or unusual headache, the contractor employee shall be asymptomatic for at least 72 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 No, assessment complete; continue to enter DOD workplace.