Shin Shinim – COVID Form COVID-19 Daily Health Checklist for SHSH COVID-19 Daily Health Checklist for SHSH COVID-19 Daily Health Checklist for SHSH This form MUST be completed every morning.If you answer yes to any of these questions, you will not be permitted to volunteer in the community until cleared by their doctor.If you answered no to all of these questions, you can continue with your day volunteer work. First Name Last Name 1. Do you have a current temperature of 100°F or higher? 1. Yes 2. No 2. Are you currently taking any medication to reduce a fever? 1. Yes 2. No 3. Do you have any of the following symptoms: cough, shortness of breath, difficulty breathing, wheezing, chills, muscle aches, sore throat, diarrhea, change in their ability to smell or taste? 1. Yes 2. No 4. Have you been exposed to someone with confirmed or suspected COVID-19 during the past 14 days? 1. Yes 2. No Submit This form MUST be completed every morning.If you answer yes to any of these questions, you will not be permitted to volunteer in the community until cleared by their doctor.If you answered no to all of these questions, you can continue with your day volunteer work. First Name Last Name 1. Do you have a current temperature of 100°F or higher? 1. Yes 2. No 2. Are you currently taking any medication to reduce a fever? 1. Yes 2. No 3. Do you have any of the following symptoms: cough, shortness of breath, difficulty breathing, wheezing, chills, muscle aches, sore throat, diarrhea, change in their ability to smell or taste? 1. Yes 2. No 4. Have you been exposed to someone with confirmed or suspected COVID-19 during the past 14 days? 1. Yes 2. No Submit A copy of your responses will be emailed to the address you provided. A copy of your responses will be emailed to the address you provided. Click To Support @akiva Programs