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ABOUT NTN
ABOUT NTN
CAREERS
OUR TEAM
COVID CHECK-IN
NEWS
TRAINING SURVEY
OUR APPROACH
PROFESSIONAL DEVELOPMENT
PROVEN METHODOLOGIES
INSTRUCTIONAL RESOURCES
KEMS
MathKEYmatics
Digital Math Resources Package
WHY NTN?
RESEARCH DATA
TESTIMONIALS
CONTACT US
NTNMath Store
LOGIN
KEMS
MathKEYMatics
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NTN Covid19 Employee Questionnaire
Erica Glover
2022-09-01T09:11:05-04:00
NTN Employee Health Screening for COVID-19
Please enable JavaScript in your browser to complete this form.
Employee Name
*
Ashley Griffin
Ashley Kane
Brandon Graham
Crystal Clayton
Donavon Harbison
Douglas Bynum
Dana Petruzziello
Eva Jennings
Gennadiy Dikovsky
Heather Thomas
Jada English
Jelina S Sheppard
Katrina Salaam
Lisa Schueren
Lynn Anne Rice
Mollie Routh
Mariam Tasleem
Nicole Beck
Natarsha Towner
Nzinga Lawrence
Patrice Francis
Pam Lucky
Ryan Davis
Rikiesha Pierce
Sarah Wood
Stacy Woodard
Tawanda Deshazior
Tiffany Thompson
Toyanika Traylor
Tracey Wallace
Valerie Thomas
Wendy Maldonado
Date
*
Please Record Your Temprature
*
Have you experienced a fever of 100.4 degrees Fahrenheit or greater, a new cough, new loss of taste or smell, shortness of breath within the past 5 days?
No
Yes
In the past 5 days, have you tested positive for COVID-19 using a test that tested saliva or used a nose or throat swab (not a blood test)? (5 days measured from the date you were tested, not the date you received the test result.)
No
Yes
To the best of your knowledge, in the past 14 days, have been in close contact (within 6 feet for at least 10 minutes) with anyone while they had COVID-19?
No
Yes
Have you been tested for COVID-19 and are awaiting the results?
No
Yes
NOTICE
No further screening is needed. You may not report to the workplace.
Please wear a mask and social distance. You should get tested 5 days from the potential exposure.
You may not report to the workplace, until 5 days have passed from testing positive.
If you answered yes to Questions 2 or 4, please note that after 5 days and you no longer have a fever, you can report to work masked with social distancing.
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