EEOC Facilities COVID-19 Screening

In order to protect the health of EEOC employees and contractors (hereby referred to as staff), all EEOC staff must self-screen for symptoms or other risk factors of COVID-19, using EEOC’s COVID-19 screening tool on their mobile device or on a paper form at designated locations at facility entrances, prior to admittance to EEOC facilities. Please see the EEOC Notice Regarding EEOC Facilities COVID-19 Screening for additional information about completing this form and the privacy of your information.

Alternative Paper Copy

As an alternative to the tool below, you can print and complete the EEOC Facilities COVID-19 Screening and show the completed form to security at the facility entrance.

Have you experienced any of the following symptoms in the past 48 hours:

  • fever or chills
  • cough
  • shortness of breath or difficulty breathing
  • fatigue
  • muscle or body aches
  • headache
  • new loss of taste or smell
  • sore throat
  • congestion or runny nose
  • nausea or vomiting
  • diarrhea

If you have had any of the above symptoms in the last 48 hours, DO NOT physically return to the workplace until symptoms have subsided for more than 48 hours. If you have a chronic medical condition that causes COVID-19-like symptoms and you need access to an EEOC facility within the next few days, please obtain medical documentation from your primary care physician to determine whether you can safely be granted access to an EEOC facility. Fully vaccinated individuals should not access a facility if they are currently experiencing any of the above symptoms. If you have an urgent need to access an EEOC facility while experiencing any of the above symptoms, please contact your supervisor. Waivers will only be granted in exigent circumstances and only if it is safe to do so. Fully vaccinated individuals will also require a waiver and should also work through their supervisor.

Please select an answer

Have you been in close physical contact in the last 14 days with:

  • Anyone who is known to have laboratory-confirmed COVID-19?

    OR
     
  • Anyone who has any symptoms consistent with COVID-19?

Close physical contact is defined as being within 6 feet of an infected/symptomatic person for a cumulative total of 15 minutes or more over a 24-hour period starting from 48 hours before illness onset (or, for asymptomatic individuals, 48 hours prior to test specimen collection).

If you have been in close contact with someone with COVID-19, you should stay home and self-quarantine for 14 days before returning to an EEOC facility. Read more about when you should be in isolation or quarantine (CDC.gov). If you have an urgent need to end your quarantine early to access an EEOC facility, please contact your supervisor. Waivers will only be granted in exigent circumstances and only if it is safe to do so. Fully vaccinated individuals will also require a waiver and should also work through their supervisor. To be considered fully vaccinated, you must be ≥2 weeks following receipt of the second dose in a 2-dose series or ≥2 weeks following receipt of one dose of a single-dose vaccine AND it must be within 3 months following receipt of the last dose in the series.

IMPORTANT: ANSWER “NO” IF YOU ARE FULLY VACCINATED

Please select an answer

Are you isolating or quarantining because you may have been exposed to a person with COVID-19 or are worried that you may be sick with COVID-19?

If you have concerns about being exposed to or sick with COVID-19, please stay home and self-quarantine or isolate. Read more about when you should be in isolation or quarantine (CDC.gov). If you have an urgent need to access an EEOC facility while quarantining, please contact your supervisor. Waivers will only be granted in exigent circumstances and only if it is safe to do so. Fully vaccinated individuals will also require a waiver and should also work through their supervisor.

Please select an answer

Are you currently waiting on the results of a COVID-19 test?

If you have an urgent need to access an EEOC facility while waiting for a test result, please contact your supervisor. Waivers will only be granted in exigent circumstances and only if it is safe to do so.

IMPORTANT: ANSWER “NO” IF YOU ARE WAITING ON THE RESULTS OF A PRE-TRAVEL COVID-19 TEST

Please select an answer

Have you traveled in the past 10 days?

Travel is defined as any trip that is overnight AND on public transportation (plane, train, bus, Uber, Lyft, cab, etc.) OR any trip that is overnight AND with people who are not in your household.

If you have an urgent need to access an EEOC facility during your 10-day, post-travel self-quarantine (CDC.gov), please contact your supervisor. Waivers will only be granted in exigent circumstances and only if it is safe to do so. Fully vaccinated individuals will also require a waiver and should also work through their supervisor. It is possible to reduce your post-travel self-quarantine (CDC.gov), to 7 days if you have a negative viral test (CDC.gov) 3-5 days after travel (CDC.gov).

Please select an answer

Access to EEOC Facilities

APPROVED

Valid for: Friday, July 1, 2022

Please show this screen to security at the facility entrance.

Thank you for helping us protect you and others during this time.

Access to EEOC Facilities

NOT APPROVED

Valid for: Friday, July 1, 2022

Click Here for Further Instructions (CDC.gov)

Thank you for helping us protect you and others during this time.