PUMP N PANTRY COVID-19 EMPLOYEE RESOURCES

Pre-Work Screening Questionnaire

ALL-EMPLOYEES-DAILY COVID-19 SCREENING QUESTONAIRE **THIS FORM MUST BE COMPLETED BY EVERY EMPLOYEE WHO ENTERS A STORE EACH DAY**
  • Date Format: MM slash DD slash YYYY
  • :
  • Temperature must be less than 100 degrees to continue to work.
  • By signing, I confirm that I have answered the above questions honestly and that if I develop signs or symptoms of respiratory illness, including fever, cough, shortness of breath, or sore throat that I will contact the store manager.