EDI OPTIONS, INC. EMPLOYEE COVID‐19 SELF‐SCREENING QUESTIONNAIRE

To reduce the risk of exposure of COVID‐19 to our employees and visitors, we are requiring employees
who come into the office to conduct a daily self‐screening exercise using this questionnaire. Your
participation is important to help us take precautionary measures to protect you and everyone at your
workplace.

This form must be submitted daily, prior to reporting to the office, to EDI Options’ Administrative
Department via email to COVID19EDIO@edioptions.com. All information is confidential.

You are REQUIRED to take your temperature before leaving home and reporting to the office.

                           Masks are required in the building and common office areas.

Failure to complete this form accurately and completely, on a daily basis when reporting to the office,
will subject you to disciplinary action up to and including discharge.

 

SELF‐DECLARATION QUESTIONS:

YesNO

YesNO

YesNO