Self Assessment Tool
Please Provide the following Information  

Which EDG Location will you access?

Your Employer
 
 
        
Your First Name  
Your Last Name  
Your Email Address  
Your Office Phone Number  
Your Mobile Phone Number  
   
Have you tested positive for COVID-19 within the last two weeks?
   
Are you currently exhibiting flu like symptoms consistent with COVID-19?
(Please refer to http://www.cdc.gov for symptoms of Coronavirus.)
   
In the last two weeks, did you care for or have close contact* with someone diagnosed with COVID-19?
   
Have you traveled outside the Continental United States or been on a cruise  in the last two weeks?
   
Have you been in contact* with anyone who traveled outside the Continental United States or been on a cruise in the last two weeks?
   
Did you measure your temperature before arriving at the EDG office today?       

You will not be allowed access to the EDG office or proceed with this survey if you did not take your temperature prior to arriving today.  You have the following options:

 • If you have not taken your temperature today, please do so and return here to complete this survey. 

• If you would like to take your temperature at the EDG office, please call 504.455.0858 for further guidance and assistance.
   
Did you have a fever (measured as temperature greater than 100.4 degrees F / 38 degrees C)?
   
* "Contact" means face-to-face contact (with or without a mask) for more than 15 minutes or being in the same enclosed space for more than 2 hours


DECLARATION AND CONSENT

 I declare all my responses to be true and correct to the best of my knowledge. I consent that EDG may collect, use and disclose my personal data, as provided in this form, in accordance to the EDG Privacy Policy (accessible at https://www.edg.net/privacy-policy/) and the above Privacy Notice. (accessible at https://www.edg.net/privacy-policy/ and the above Privacy Notice.