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.

    In the past 14 days have you:

    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:
    1. Wear a mask whenever you are not in your classroom seat (e.g. entering, exiting, bathroom, etc.)
    2. Provide your own writing utensil
    3. Provide/obtain your own food and beverages (storage will not be provided)
    4. Use provided hand sanitizer when entering/exiting
    5. Wipe down your table and chairs at end of class with provided disinfectant
    6. Maintain 6’ of personal space at all times
    7. Limit to one person in restroom at any time
    8. Do not congregate in lunch or break room areas
    9. Breaks/lunches should be taken outdoors as much as possible
     
    Safety Reminders:
    1. Do not share office or protective equipment
    2. Use sanitizer before touching community items
    3. Avoid physical contact by discontinuing contact greetings such as hugs and handshakes and practice social distancing
    4. Wash hands frequently for at least 20 seconds with soap and water
    5. Limit face-to-face interactions as much as possible
    6. Use disposable gloves if you feel more comfortable doing so
    7. Cover nose and mouth when coughing or sneezing with arm or tissue, dispose of tissue after use and wash hands after coughing or sneezing
    8. Avoid touching face (mouth, eyes, nose)

    What to expect:
    1. Cleaning and sanitizing supplies will be provided
    2. Class sizes will be within health mandated requirements
    3. Building and classroom doors will be wedged open