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HEALTH QUESTIONNAIRE
The purpose of this questionnaire is to conduct COVID-19 screening of all individuals attending a training class. Because your health has the potential to affect the health of other people in this class, as well as their families and others, it is essential you answer these questions honestly.
In the event someone in the class has been in close contact with someone probable or confirmed with COVID-19, your contact information is necessary so we can inform you that your health and safety may be at risk. All medical information will be treated confidentially and only disclosed to others when required to meet our obligation to maintain a safe workplace.
*
Indicates required field
Name
*
First
Last
Class Date
*
Phone Number
*
Email
*
Confirm Class
*
AK-CESCL 2-Day Initial Anchorage
AK-CESCL 2-Day Initial Fairbanks
AK-CESCL 1-Day Refresher Anchorage
AK-CESCL 1-Day Refresher Fairbanks
CQM Anchorage
CQM Fairbanks
SWPPP
Other
If you chose other as class type, identify class here:
*
In the past 14 days have you:
Had an onset of cough, shortness of breath, chills, headache or fever of 100.3 or higher?
*
Yes
No
Been tested for COVID-19 and are awaiting results, diagnosed with COVID-19, or contacted by a State Department of Health that you may have been exposed to COVID-19?
*
Yes
No
Experienced shortness of breath at rest or not related to exertion, inability to lie down because of difficult breathing, difficulty managing chronic health conditions because of difficulty breathing, or any type of respiratory illness?
*
Yes
No
Experienced any abnormal or unusual conditions (not associated with allergies, smokers cough, other known respiratory complaints, etc.) such as coughing, sneezing, sore throat?
*
Yes
No
Provided care or have close contact with a person with COVID-19 (probable or confirmed) while they were ill (cough, fever, sneezing, or sore throat)?
*
Yes
No
Have you travelled outside of Alaska within the last two weeks?
*
Yes
No
Have you had to quarantine within the last two weeks?
*
Yes
No
If you have checked NO but you notice a change in your health within the next 14 days, we ask you to contact your class sponsor at 907-561-5354 or Training@agcak.org
Be prepared to follow the following safety protocols while attending this class:
Wear a mask whenever you are not in your classroom seat (e.g. entering, exiting, bathroom, etc.)
Provide your own writing utensil
Provide/obtain your own food and beverages (storage will not be provided)
Use provided hand sanitizer when entering/exiting
Wipe down your table and chairs at end of class with provided disinfectant
Maintain 6’ of personal space at all times
Limit to one person in restroom at any time
Do not congregate in lunch or break room areas
Breaks/lunches should be taken outdoors as much as possible
Safety Reminders:
Do not share office or protective equipment
Use sanitizer before touching community items
Avoid physical contact by discontinuing contact greetings such as hugs and handshakes and practice social distancing
Wash hands frequently for at least 20 seconds with soap and water
Limit face-to-face interactions as much as possible
Use disposable gloves if you feel more comfortable doing so
Cover nose and mouth when coughing or sneezing with arm or tissue, dispose of tissue after use and wash hands after coughing or sneezing
Avoid touching face (mouth, eyes, nose)
What to expect:
Cleaning and sanitizing supplies will be provided
Class sizes will be within health mandated requirements
Building and classroom doors will be wedged open
By checking this box, you confirm you answered truthfully, read thoroughly, and agree to abide by these expectations.
*
I am responsibly preventing the spread of COVID-19
Submit
About AGC
Staff & Contact
Board of Directors
Member Testimonials
History
Construction Industry Progress Fund
AGC Privacy Policy
AGC Services
AGC Online Plans
Training Room Rental
Education
>
CESCL, CQM & More
Scholarships
UAF Student Chapter
UAA Construction Management Student Organization
AGC Health Benefits
Advocacy
AGC Retirement & 401k Plan
Job Board
Hire UAA Construction Management Students
Operation Opening Doors
AGC Network & Events
Events Calendar
Annual Events
Publications & Archives
Podcast: Build Alaska
Committees
Construction Leadership Council
Awards
>
Hard Hats
Excellence in Construction
Excellence in Safety
Volunteer of the Year
Membership
Join
Benefits
Dues
Pay an Invoice
AGC of America Benefits
All Star Program
Member Directory
Member Login
Industry
Safety Database
Labor Agreements
Partner Organizations
Laborers' & Mechanics' Minimum Rates of Pay - Pamphlet 600
DOT DBE Directory
DOL Certified Payroll Forms
Online Plans Login
Online Plans Login
Weekly Bid Results
MoA Permit Activity Reports
beta.SAM.gov Quick Start Guide
DOT Bid Express FAQs