The completion of this COVID-19 screening assessment is a commitment to my health and to the health and well-being of others.

Please complete the form below ensuring your responses are honest and provide an accurate reflection of your current health condition.


SHIP COVID-19 Screening Assessment for Staff
Are you fully vaccinated against COVID-19? *
Are you currently experiencing any of these issues? If yes, call 911 immediately and notify your Manager. Do not continue the screener. *
In the past 14 days have you been directed by a federal border agent to comply with federal quarantine requirements due to international travel? *
In the last 5 days have you experienced any of these symptoms? *
Do any of the following apply? You live with someone who is currently isolating because of a positive COVID-19 test. You live with someone who is currently isolating because of COVID-19 symptoms. You live with someone who is isolating while waiting for COVID-19 test results. Select "No" if you: are 18 or older and have received your booster dose, or are 17 or younger and are fully vaccinated, or completed your isolation after testing positive in the last 90 days (using a rapid antigen, rapid molecular, or PCR test). *
In the last 5 days, have you tested positive on a rapid antigen test, molecular test, or home-based self-testing kit? Select “No” if you have already completed your isolation period of 5 days because your symptoms started before your positive test result, and: you do not have a fever, and your symptoms have been improving for 24 hours (48 hours for nausea, vomiting, and/or diarrhea). *
Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)? This can be because of an outbreak or contact tracing. *