Name: Baltimore Home Cleaning
Address: 2 South Patterson Park Ave, Baltimore, MD, 21231, United States
Telephone: +1-443-432-4201
Price range: $$

Health Screening

Ask the employee the following questions:

Do you have any of these symptoms: fever, aches, cough, shortness of breath, chills, muscle pain, headache, sore throat, new loss of smell?*

Yes
No

Have you come in contact with anyone diagnosed with COVID-19?*

Yes
No

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

Yes
No

Have you traveled outside Maryland over the last 14 days?*

Yes
No

Acknowledgements*

I understand my responsibility to not come to work if I have symptoms of COVID-19 or have recently come into contact with someone who has COVID-19.
I understand my responsibility to comply with Baltimore Home Cleaning’s health and sanitation standards.

Record the employee's temperature:*

Your Name*

First Last

Employee Name*

First Last

Manager Pre-Shift Survey

Health Screening