3M Employee Quick Self Reporting Questionnaire

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1. Have you tested positive for COVID-19 in the past 10 days and not been cleared by the OHN/DPC?
2. Have you been in close contact in the past 10 days with anyone who has tested positive or was clinically diagnosed with COVID-19 and not been cleared by the OHN/DPC?
3. Have you experienced any of the following symptoms in the past 10 days and not been cleared by the OHN/DPC?
- Fever or chills
- Cough
- Fatigue
- Muscle or body aches
- Headache
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea or vomiting
- Diarrhea
- Shortness of breath or difficulty breathing
How do you answer the above questions? Click your answer below.
- I answer "No" to ALL of the above and I am safe to enter.
- I answer "Yes" to one or more of the above. I will return home and contact Site Occupational Medicine.
The information you provide on this form will be used to make and record facility entrance decisions in accordance with applicable screening guidelines. It will be kept confidential according to the applicable law and 3M Policies.

Please be aware that this information (including the original and the subsequent reply) may be transferred to a server located in the U.S. for metrics and storage. If you do not consent to this use of your personal information, please do not use this system.
Submit

You may now enter the building.

If you are a 3M employee, please notify your supervisor immediately that you are not permitted to enter the facility. In addition, contact the onsite Occupational Health Nurse/Disease Prevention Coordinator for guidance.
If you are a NOT a 3M employee (contractor, visitor, contingent worker, etc.) contact your employer and seek medical attention. Notify your 3M contact/host that you cannot enter the facility.

If you continue to receive this error, please contact the 3M IT Helpdesk.

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