Wellness Check

Is this submission for an Employee or Guest? *

Who is the brewery contact for the guest? *

Location *

Name *

First & Last

Skin Temperature Reading *

SYMPTOM CHECKLIST

Yes

No

Skin Temperature reading of above 98.6ºF? *

Yes

No

Cough? *

Yes

No

Shortness of breath or difficulty breathing? *

Yes

No

Chills? *

Yes

No

Muscle aches? *

Yes

No

Sore throat? *

Yes

No

New loss of taste or smell? *

Yes

No

Select your Department or Manager name *

Your form submission will be emailed to your manager. If submitting for a guest, please select the brewery contact's department.

reCAPTCHA

If your skin temperature is above 98.6º F according to the Infrared Forehead Thermometers, you need to go home immediately and inform your supervisor. Clock out (if applicable) and DO NOT enter any other building. Please refer to the most recent version of the Plan to Address Staff Reports of COVID-19.