Call Off

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Fill out the form to create a Call Off.

Facility Name

Your First and Last Name

Call Off Date

Date Format: YYYY-MM-DD

Call Off Reason

Do you have a temperature greater than 99.4?

Yes No

Have you been in close contact (within 6 feet whether wearing a mask or not) with any individual (including family) actively diagnosed with COVID-19 or being tested for COVID-19?

Yes No

Have you recently received a COVID-19 vaccination?

Yes No

Do you have any of the following symptoms:

Chills
Cough
Shortness of breath or difficulty breathing
fatigue
muscle or body aches
headache
new loss of taste or smell
sore throat
congestion or runny nose
nausea, vomiting, or diarrhea?

Yes No