TAB 10 Health Screening.pdf

Department of Justice Visitor Health Self-Screening

This form should be reviewed and completed by all visitors to Department of Justice facilities. While the Department will not collect them, after completing the form visitors should be ready to acknowledge completion to security personnel and/or the visitor’s sponsor at the point of entry. Failure to acknowledge completion of the questionnaire and present the additional documentation required (Certification of Vaccination and/or negative COVID-19 test results) may result in denial of entry to Department of Justice buildings and facilities.

In most cases, visitors will be asked only to acknowledge they have assessed their health on the day of the visit using this form. While visitors are encouraged to complete the questionnaire in writing, they typically will not be required to submit or show the questionnaire to security personnel and/or the sponsor of the visit meeting them at the point of entry.

Health Screening Questions

Please consider all questions that apply to you and follow the directives and recommended steps below based on your response:

1. Regardless of your vaccination status, have you experienced any of the symptoms in the list below in the past 48 hours? Consider answering “yes” even if you believe the symptom(s) is because of some other medical condition (for example, consider answering “yes” if you have a runny nose that you believe is because of allergies).

• Fever or Chills • Severe Muscle or Body Aches

• Nausea or Vomiting

• Cough • Sore Throat • Diarrhea

• Shortness of Breath or

Difficulty Breathing

• New Loss of Taste or

Smell

• Congestion or Runny

Nose

Yes No

If your answer is “Yes” to having any of these symptoms please reschedule your visit.

Please consider rescheduling your visit if you have the following symptoms:

• Fatigue

• Headache

2. Have you tested positive for COVID-19 or are you worried that you may be sick with COVID- 19?

Yes No

If your answer is “Yes” you may not enter Department of Justice facilities at this time.

If you have concerns about being exposed to or sick with COVID-19, please stay home and self-quarantine or isolate. Read more about when you should be in isolation or quarantine (https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html).

3. Have you been in close physical contact in the last 14 days with:

https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html

• Anyone who is known to have a confirmed case of COVID-19? OR

• Anyone who has any symptoms consistent with COVID-19?

Close physical contact is defined 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).

If you have been in close contact with someone with COVID-19 and you are not fully vaccinated, you should stay home and self-quarantine for 14 days before returning to Department of Justice facilities. Read more about when you should be in isolation or quarantine (https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html).

If you have been in close contact with someone with COVID-19 and you are fully vaccinated, you should stay home and get tested 3-5 days after your exposure, even if you don’t have symptoms. Read more about what to do if you’ve had a close contact and are fully vaccinated (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html).

4. If your answer is “Yes” to question 3 above, were you tested 3-5 days after your exposure with the close contact?

Yes No

If your answer is “No” you should reschedule your visit until you have received a negative test result. If your answer is “Yes” but, consistent with CDC guidance, you have received a negative test for COVID-19 within the past three days, please present your attestation form and test results and proceed as scheduled.

5. Are you currently waiting on the results of a COVID-19 test based on actual or suspected exposure to someone infected with COVID-19? Important: This does not apply to routine screening tests, such as pre- or post-travel testing not triggered by suspected exposure.

If your answer is “Yes” you may not enter Department of Justice facilities at this time, and should follow all CDC-recommended guidelines depending on the results of your test.

If based on your responses you must reschedule your visit to Department of Justice facilities, please see the instructions below:

• If you are not already at home, please avoid contact with others and go home immediately.

• Seek medical advice and care as needed.

• Seek COVID-19 testing as recommended.

• In case of a life-threatening medical emergency, dial 911 immediately.

• Contact the sponsor of your visit or other official to reschedule your visit when it is safe for you to do so.

https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html