Please enable JavaScript in your browser to complete this form.Symptom Check *FeverFatigueCoughSneezingMuscle aches and painsSore throatDiarrheaHeadachesShortness of breath or difficulty breathingNew loss of smell and/or tasteChillsI have experienced none of the COVID-19 symptomsIn the past 24 hours, have you experienced any COVID-19 symptoms?Symptomatic Contact *YesNoHave you recently been in close contact with anyone who has exhibited any symptoms of COVID-19?Positive Contact *YesNoHave you recently been in close contact with anyone who has tested positive for COVID-19?Temperature Check *Please provide the reading of a self-administered temperature screening taken within the last 4 hours. (degrees Fahrenheit) Consent *I consent to pre-shift employee COVID-19 screening.This information is being collected as part of Dashe Cellars' efforts to maintain a safe work environment. Records are maintained as confidential documents in compliance with California privacy laws and the Americans with Disabilities Act.Attestation *I attest that my answers are true and correct.Signature *FirstLastDate *NameSubmit FacebookTwitterPinterestEmail
